FLUID AND ELECTROLYTE Part -1 - PowerPoint Presentation

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FLUID AND ELECTROLYTE

Part -1Repersented by : Dr. Mohan Kumar M.S.(Ay.)

Introduction

Can You Imagine life without water?Of course not, because water is essential to

sustain

life. Total body water (TBW)- approximately 60% of total body weightThis can be 70% or higher in a new born.Total Body Fluid can be divided into Intracellular and Extracellular

INTRACELLULAR

FLUID20 LITER 2/3 OF THE TOTAL

BODY

WATER .FOUND INSIDE THE PLASMA MEMBRANE OF THE BODY'S CELLS.

Extracellular

Fluid 10 liter -1/3 of

the

TBW, either: Plasma ¼( 2.5) literInterstitial fluid 7.5 literInterstitial, Intravascular and 3rd space1- Interstitial

compartment

It

the

small, narrow spaces between tissues or parts of an organ. It is filled with what is called interstitial fluidWhen excessive fluid accumulates in the interstitial space oedema develops.

EXTRACELLULAR

FLUIDTHIRD SPACEThe third

space

is space in the body where fluid does not normally collect in

larger

amounts.

For

examples the peritoneal cavity and pleural cavity are major examples of the third space.

INDICATION

Rapid restoration of fluid and electrolyte in dehydration due to vomiting, diarrhoea, shock, due to haemorrhage, sepsis or burns.Total parenteral nutrition.Anaphylaxis, cardiac arrest, hypoxia.Post gastrointestinal surgeries.

Water requirements

increase with:Fever SweatingBurns TachypneaSurgical drains Polyuria

Gastrointestinal

losses through Vomiting or diarrhoeaWater requirements increase by 100 to 150 mL/day for per degree Celsius of body temperature elevation.

Types

of FluidThe fluids can be classified into crystalloids, colloids and

blood

products1. CrystalloidsCrystalloids are aqueous solutions of mineral salt and other water soluble molecules. They are use to improve the volume and electrolyte supplement.

5% Dextrose

It provides 170 calories per liter,

but

it doesn't replace electrolytes.One liter contains 50 gm of glucose.It is hypotonic.

Indication

Pre and post operative fluid therapy.5%-10% Dextrose used in obstructive jaundice (protector of liver).Used in hypernatremia due to pure water loss like Diabetes insipidus.

Contraindication

Renal failure Cerebral o

edema

Never

mix dextrose with blood as it causes blood to

haemolyse.

Not

used

for resuscitation, because the solution won't remain in the intravascular space.Not used in the early postoperative period, because the body's reaction to the surgical stress may

cause

an

increase

in

antidiuretic

hormone

secretion

Note IV Dextrose can cause low potassium magnesium and phosphate and cause thrombophlebitis.

NS (isotonic saline) 0.9%

One liters contains 154 mEq each of sodium and chlorideINDICATION To treat hypovolaemia

,

as in fluid volume deficit from Haemorrhage - Severe vomiting or diarrhoea - Heavy drainage

from

G I

suction, intestinal

fistulas,

or

woundsShockMild hyponatremia, hypercalcaemiaMetabolic acidosis (such as diabetic ketoacidosis), alkalosisIt’s the fluid of choice for resuscitation efforts.it's the only fluid used with administration of blood products.used to wash the body cavity and like peritoneum.

Contraindication

1. Avoid in hypertension, preeclampsia, elderly dehydration with hypokalaemia.2. Large volume infusion cause sodium retention cause fluid overload and hypochloraemia

.

DNS(5% NS & 0.9% NaCl

)Indication- Hypovolaemia, hyponatraemiaAlkalosis due to vomiting and nasogastric aspiration.

Contraindication

Not use in cardiac and renal failure.Used in shock but not in severe hypovolemic shock.

Ringer's lactate

or Hartmann solutionIndicationIt is devoid of glucose.Used in metabolic acidosis as lactate in liver is metabolised to bicarbonate.

Another

choice for first-line fluid resuscitation for certain patients, such as

those

with

burn

injuries, post operative period, diarrhoea.Diabetic ketoacidosis it provide glucose free fluid.Patients experiencing acute blood loss or hypovolemia due to third-space fluid shifts.

Contraindication

It cause lactic acidosis so contraindicated in hypoxia, sever shock, liver disease, in vomiting and nasogastric aspiration, in metabolic alkalosis.Don't give RL

to

patients with liver disease as they can't metabolize lactateRL and blood not infused simultaneously. Blood precipitate due to calcium.RL

shouldn't

be

given to a patient whose pH is greater than 7.5

ISOLYTE-M (MAINTENANCE)

INDICATIONRich potassium in it is useful in correcting the hypokalemia.It is used in acidosis also.Used in diarrhoea, bilious vomiting.CONTRAINDICATIONNot used to correct hyponatraemia as sodium concentration is low in it.

ISOLYTE-G (Gastric)

INDICATIONGastric juice vomitingNasogastric aspirationMetabolic alkalosis

ISOLYTE-E (Extracellular replacement)

INDICATIONIt used mainly to replace extracellular fluid.CONTRAINDICATIONNot used in metabolic alkalosis due to vomiting or due to diuretic.

ISOLYTE-P (P

ediatric)INDICATIONUsed in fluid therapy in paediatric age groupCONTRAINDICATIONNot used to correct hyponatraemia, renal failure, hyperkalaemia, hypovolaemic

shock.