Basic Fluids and Electrolytes. Douglas P. Slakey. Why ? . Essential for surgeons (and all physicians) Based upon physiology Disturbances understood as pathophysiology To Encourage Thought Not Mechanical Reaction Most abnormalities are relatively simple, and many iatrogenic.
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Douglas P. Slakey
To Encourage Thought Not Mechanical Reaction
Most abnormalities are relatively simple, and many iatrogenic
TOTAL BODY WATER you're a fool than to open it and remove all doubt.
60% BODY WEIGHT
I Love Salt Water! you're a fool than to open it and remove all doubt.
Electrolytes you're a fool than to open it and remove all doubt.
(mEq/L) Plasma Intracellular
Na 140 12
K 4 150
Ca 5 0.0000001
Mg 2 7
Cl 103 3
HCO3 24 10
Protein 16 40
2 X Na + Glc + BUN
Dehydration you're a fool than to open it and remove all doubt.
Chronic Volume Depletion
Affects all fluid components
Solutes become concentrated
Hct can increase 6-8 pts for 1 L deficit
Patients at risk:
Cannot respond to thirst stimuli
Treatment: typically low Na fluids
Isotonic fluid loss, from extracellular compartment
Hemorrhage, NG, fistulas, aggressive diuretic therapy
Third space shifting, burns, crush injuries, ascites
Replace with blood/isotonic fluid
Then may take a long time to return to circulation
To Replace Ongoing Losses, NOT Pre-existing Deficits
Maintenance Fluids you're a fool than to open it and remove all doubt.
D5 0.45NS + 20 mEq KCl/L at 125 ml/hr
(If 0.2 NS: 3 liters X 2 grams Na = 6 grams Na)
Too much ADH
Increased plasma volume, dilutional hyponatremia, decreases aldosterone
Increased Na excretion (Ur Na >40mEq/L)
Fluid shifts into cells
Symptoms: thirst, dyspnea, vomiting, abdominal cramps, confusion, lethargy
Loop of Henle
Relatively too little H2O
Free water deficit:
[0.6 X wt (kg)] X [Serum Na/140 - 1]
The End you're a fool than to open it and remove all doubt.