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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
EnteralNutrition :
  • Enteral + Parenteral
  • Parenteral
enteral nutrition
OralEnteral Nutrition :
  • Nasogastric tube
  • Orogastric tube
  • Gasterostomy tube
  • Jejunostomy tube
energy expenditure
> 20% burnEnergy Expenditure:

100%

  • Severe infection

50%

  • Multiple Fx

20%

  • Normal

BEE

nutritional assessment
Basal energy expenditureNutritional assessment:
  • Previous malnutrition
  • Severity of disease
  • Physical activity
basal energy expenditure
Harris & BenedictBasal energy expenditure:

Weight (kg)

Height (cm)

Age (year)

basal energy expenditure1
Adult 30-35 Kcal/kgBasal 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 anomalyIndication 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 dyingContraindication 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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