قراءة
عرض

General Surgery

Mosul university- College of dentistry-oral & maxillofacial surgery department
Dr. Ziad H. Delemi
B.D.S, F.I.B.M.S (M.F.)
Fluid Therapy

Mosul university- College of dentistry-oral & maxillofacial surgery department

Paraenteral administration
Is the administration of the fluid by any route other than alimentary tract.
Indications:
In patient unable to take fluid for any reason or is not enough.
In post operative period.

Mosul university- College of dentistry-oral & maxillofacial surgery department

Rule of Approximate Thirds

2/3 of body weight is water (lean person)
Body water
2/3 intracellular
1/3 extracellular
Extracellular water
2/3 extravascular
1/3 intravascular

Mosul university- College of dentistry-oral & maxillofacial surgery department

Input and output

In put means fluid taken by the patient Output = urine output + insensible lossNormal urine output 1 ml /kg /hour (adult)Normal daily requirement about 2 litersFluid should be isotonic (not hyper or hypotonic)First 24hrs no Na is needed bec. ADH→↑Aldost.Best one is 5% Dextrose solution

Mosul university- College of dentistry-oral & maxillofacial surgery department

Normal Water Exchange

Average daily \ml
Sensible urine 800-1500 intestinal up to 10,000 sweat up to liters
Insensible lungs/skin 600-900

Mosul university- College of dentistry-oral & maxillofacial surgery department

70 kg Patient

Total body water - 42 L
Intracellular - 28 L
Extracellular - 14 L
Intravascular - 3 L
Interstitial - 11 L

Mosul university- College of dentistry-oral & maxillofacial surgery department

Causes of Fluid Loss

Gastrointestinal loss
Fever
Blood loss
Burns
Peritonitis
Fluid shifts
Diuretics
Inhalation of dry gases

Mosul university- College of dentistry-oral & maxillofacial surgery department

Signs of Hypovolemia

Tachycardia
Orthostatic hypotension
Flat neck veins when supine
Decreased CVP
Decreased urine output
Dry membranes
CV collapse

Mosul university- College of dentistry-oral & maxillofacial surgery department

Ringer’s Lactate
Most commonly used solution in the O.R.
Slightly hypotonic - 100 ml free water / liter
Most physiologic solution when large volumes are needed
Lactate metabolizes in liver to bicarbonate

Mosul university- College of dentistry-oral & maxillofacial surgery department

Normal Saline

Large volumes cause dilutional hyperchloremic acidosis
Preferred solution for:
Hypochloremic metabolic acidosis
Diluting packed cells

Mosul university- College of dentistry-oral & maxillofacial surgery department

5% Dextrose in Water

Dextrose is metabolized leaving a large volume of free water
Used for patients on sodium restriction
Some dextrose needed when insulin is given

Mosul university- College of dentistry-oral & maxillofacial surgery department

24 Hour Formula

100 ml for 1st 10 kg
50 ml for 2nd 10 kg
20 ml for remaining kg

1 ml of fluid = 15 drops

Mosul university- College of dentistry-oral & maxillofacial surgery department

24 Hour Formula

Formula =volume of fluid per CC * 15/ number of hours * 60

Mosul university- College of dentistry-oral & maxillofacial surgery department

Example

82 kg patient100 ml for 1st 10 kg= 1000 ml50 ml for 2nd 10 kg= 500 ml20 ml for 62 kg= 1240 mlTotal = 2740 ml2740 * 15/ 24 *60 ≈ 28 drop per minute ( one drop every two seconds)

Mosul university- College of dentistry-oral & maxillofacial surgery department

Post operative fluid therapy

Immediate post op. period:
assessment of vital signs
maintenance fluid
unnecessary to give potassium during 1st 24 hr

Late post op. period:
replace the sensible & insensible loss
in fever every 1 degree, increased loss by 250 ml\day

Mosul university- College of dentistry-oral & maxillofacial surgery department

Fluids needed post op.

1st day 2 liter 5% dextrose
2nd day 2 liter 5% dextrose + 1 liter N\S
3rd day 2 liter 5% dextrose + 1 liter N\S + 20 meq K+ for each liter (60meq)

Mosul university- College of dentistry-oral & maxillofacial surgery department

Complications

volume excess ( over hydration)

post op. hyponatremia
post op. hypernatremia
high out put renal failure

Mosul university- College of dentistry-oral & maxillofacial surgery department

Quiz

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المشاهدات: لقد قام 5 أعضاء و 69 زائراً بقراءة هذه المحاضرة






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