Fluid therapy in medical disorders
As diarrheal fluid is rich in sodium, bicarbonate and potassium diarrhea leads to hypokalemic hyperchloremic metabolic acidosis with dehydration. Mild dehydration: up to 5% total body water (2 to 3L in 70kg man) Normal mental state, dry mucous membranes, usually thirsty, blood pressure and heart rate normal, lower than normal urine output and skin turgor almost normal. Moderate dehydration: 5-10% total body water (4 to 5 L in 70kg man) Disinterest in surrounding, can be drowsy, increased heart rate and respiratory rate, orthostatic hypotension, decreased skin turgor and reduced urine output Severe dehydration: 10-15% total body water (7 to 8 L in 70kg man) Reduced conscious level, fast heart rate, low blood pressure, respiratory distress and oliguria/anuria
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Fluid therapy in medical disorders
- 1. Dr. Lokesh Garg MBBS MD.(Med.) SANTOSH HOSPITAL YAMUNA NAGAR
- 2. Why to discuss fluid Therapy
- 3. Why patients need intravenous fluid therapy ? Patient needs IV fluid therapy for Maintenance ( to supply daily needs ) , Replacement ( to replace deficit and on-going losses ) Resuscitation ( to correct an IV or extracellular deficit )
- 4. Planning and preparing prescription of intravenous fluids
- 5. Step 1 : Assessment
- 6. Step 2: Calculation of volume of intravenous fluids
- 7. Step 3 : Selection of intravenous fluids
- 8. Step 4 : Determine rate of fluid administration
- 9. How much fluid to give ?
- 10. Assessment of volume status Mild dehydration: up to 5% total body water (2 to 3L in 70kg man) Normal mental state, dry mucous membranes, usually thirsty, blood pressure and heart rate normal, lower than normal urine output and skin turgor almost normal. Moderate dehydration: 5-10% total body water (4 to 5 L in 70kg man) Disinterest in surrounding, can be drowsy, increased heart rate and respiratory rate, orthostatic hypotension, decreased skin turgor and reduced urine output Severe dehydration: 10-15% total body water (7 to 8 L in 70kg man) Reduced conscious level, fast heart rate, low blood pressure, respiratory distress and oliguria/anuria
- 11. Which fluid to give ? Intravenous fluids to be infused in a given patient is selected on the basis of Composition of IV fluids . Underlying etiology and presence of electrolyte and acid-base disorder. Selection of intravenous fluids (considering its composition)
- 12. Sodium concentration of various intravenous fluids Intraveno us fluids Isotonic saline Ringer's lactate 5% / 10% dextrose Isolyte-G Isolyte-M Isolyte-P Na (mq/L) 154 130.0 25 63 40 25
- 13. Potassium concentration of various intravenous fluids Intraveno us fluids Ringer's lactate Isolyte-GIsolyte-M Isolyte-P k(mEq/L) 4.017.035.0 20.0 KCl (15%)Amp 20 mEq/10 ml
- 14. Characteristics of intravenous fluids Characteristic Intravenous fluids Characteristic Intravenous fluids Most physiological RL Glucose free Saline, RL Rich in sodium NS,DNS,RL Sodium free Dextrose solutions Rich in chloride NS,DNS,Iso-G Potassium free NS/DNS,dextrose solution Rich in potassium Iso-M,P and G Avoid in liver failure RL, Iso-G, 5% D Corrects acidosis RL, all isolyte Except Iso-G Avoid in renal failure NS, RL, all isolyte Corrects alkalosis Isolyte-G, NS Provides phosphorous Isolyte-M
- 15. Selection of intravenous fluid in common clinical problems
- 16. Fluid therapy in hypovolemic shock :
- 17. Selection of intravenous solution for initial treatment of hypovolemic shock
- 19. Isotonic saline is most preferred
- 20. Ringer’s lactate ( RL)
- 21. Colloids , albumin, blood products most effective agents
- 22. Fluid Therapy in Diarrhea
- 23. Fluid Therapy in Diarrhea Patients with severe dehydration and shock need IV fluid therapy RL is most preferred IV fluid to correct dehydration
- 24. Fluid therapy in vomiting Vomiting leads to hypokalemic hyperchloremic metabolic alkalosis with dehydration. Most preferred IV fluid to correct dehydration due to vomiting is isotonic saline (NS)
- 25. Fluid therapy in initial phase of stroke Avoid 5% dextrose – • it is hypotonic fluid and increases brain edema • Leads hyperglycemia and enhances brain injury Isotonic saline (NS) is the ideal IV fluid
- 26. Take Home message Clinical disorder Ideal initial fluid Clinical disorder Ideal initial fluid Hypovolemic shock NS,RL Burns Ringer’s lactate Diarrhea Ringer’s lactate Intraoperative Ringer’s lactate Vomiting Isotonic saline Starvation deficit 5% dextrose Diabetic ketoacidosis Isotonic saline Hypokalemia Isolyte-M, KCl drip Adult maintenance Isolyte-M SIADH 3%NaCl + IV frusemide Post TURP NS, Avoid 5% D Stroke, neuro surg. NS. Avoid dextrose sol