Water exchang
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Water exchang :. Daily intake 2000 – 2500 cc. by mouth 1500 cc. in solid food 500 – 1000 cc. Daily output. urine 800 - 1500 cc. stool 250 cc.

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Water exchang

Water exchang :

  • Daily intake 2000 – 2500 cc

by mouth 1500 cc

in solid food 500 – 1000 cc

  • Daily output

urine 800 - 1500 cc

stool 250 cc

insensible loss 600 cc


Daily water requirement

Adult 30-35 cc/kg

2000 – 2500 cc

Daily water requirement :

  • Child

1st 10 kg wt 100 cc/kg

2nd 10 kg wt 50 cc/kg

Each additional kg 20 cc/kg


Electrolyte requirement

Electrolyte requirement:

  • Adult

    Na 50 – 90 meq / day

    K 60 meq / day

  • Child

  • Na 3 meq / kg / day

  • K 2 meq / kg / day


Volume changes

Volume changes :

  • Volume deficit

Vomiting

Peritonitis

Diarrhea

Obstruction

  • Volume excess

Iatrogenic

Renal failure

Cirrhosis

Heart failure


Acid base balance

Acid-Base balance :

  • Important Buffers

Intracellular

Proteins

Phosphate

Extracellular

Bicarbonate – Carbonic acid


Acid base disorders

Acid-Base disorders :

Acute

  • Respiratory

Chronic

  • Metabolic

Acute

Chronic


Acid base disorders acute

Acid-Base disorders : (acute)

pH

pco2

HC03

  • Respiratory

N

Acidosis

  • Respiratory

N

Alkalosis


Acid base disorders chronic

Acid-Base disorders : (chronic)

pH

pco2

HC03

  • Respiratory

Acidosis

  • Respiratory

Alkalosis


Acid base disorders acute1

Acid-Base disorders : (acute)

pH

pco2

HC03

  • Metabolic

N

Acidosis

  • Metabolic

N

Alkalosis


Acid base disorders chronic1

Acid-Base disorders : (chronic)

pH

pco2

HC03

  • Metabolic

Acidosis

  • Metabolic

?

Alkalosis


Solutions meq l

Solutions : (meq/L)

Na

K

Ca

Cl

Hco3

  • Extracellular F.

142

4

5

103

27

4

--

109

28

130

  • Lactated ringer

  • Nacl 0.9 %

154

--

--

154

--


Solutions meq l1

Solutions : (meq/L)

Na

K

Ca

Cl

Hco3

  • D5%W

--

--

--

--

--

52

--

--

52

--

  • 1/3 2/3

  • 3% Nacl

513

--

--

--

513


A resonable solution for maintenance

A resonable solution for maintenance:

  • D5% 45% Nacl + K

  • Adult 1/3 2/3 + K

  • Child D5% W + K + Na


Nonfunctional fluids

Nonfunctional fluids:

( Third space )

  • Ascites , Pleural effusion

    The bowel wall , Peritoneum , …


Rate of fluid administration

Rate of fluid administration:

  • Severity of disturbance

  • Type of disturbance

  • Ongoing loss

  • Cardiac status


1 cc fluid

1 cc Fluid

  • 15 Drops

  • 60 Microdrops


Adequate volume replacement

Adequate volume replacement :

  • Normal Pulse rate

  • Normal Blood pressure

  • Adequate Urine output

Adult 30 – 35 cc / hr

Child 0.5 – 1 cc / kg / hr


Nutrition in the surgical patients

Elective operation ( 100g glucose/day)

Nutrition in the surgical patients:

  • Elective operation in seriously ill patient


Nutrition

Enteral

Nutrition :

  • Enteral + Parenteral

  • Parenteral


Enteral nutrition

Oral

Enteral Nutrition :

  • Nasogastric tube

  • Orogastric tube

  • Gasterostomy tube

  • Jejunostomy tube


Energy expenditure

> 20% burn

Energy Expenditure:

100%

  • Severe infection

50%

  • Multiple Fx

20%

  • Normal

BEE


Nutritional assessment

Basal energy expenditure

Nutritional assessment:

  • Previous malnutrition

  • Severity of disease

  • Physical activity


Basal energy expenditure

Harris & Benedict

Basal energy expenditure:

Weight (kg)

Height (cm)

Age (year)


Basal energy expenditure1

Adult 30-35 Kcal/kg

Basal energy expenditure:

  • Child for each ml water 1 kcal

1st 10 kg wt 100 ml/kg

2nd 10 kg wt 50 ml/kg

Each additional kg 20 ml/kg


Parenteral alimentation

Maximum benefit

(calory/ nitrogen = 100-150 kcal/g)

Parenteral Alimentation:

20%

  • Infused simultaneously


Indication of iv alimentation

Newborn with GI anomaly

Indication of IV alimentation :

  • Malabsorption or GI enzyme deficiency

  • Adult with short bowel syndrome

  • Prolonged paralytic ileus

  • Patient who cannot ingest food


Contraindication of iv alimentation

Postpound inevitable dying

Contraindication of IV alimentation :

  • Severe metabolic derangement

  • Normal GI tract feeding

  • Decerebrated or dehumanized

  • Infant < 8 cm small bowel

  • Good nutritional status


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