fluid thrapy

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 Sensibleurine 800-1500 intestinal up to 10,000 sweat up to liters Insensiblelungs/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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