Fluids
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This document discusses the fluid composition of the human body and various intravenous fluid options. It notes that the typical adult human body contains 42 liters of total water, with 15 liters extracellular and 3 liters as plasma. Common IV fluid options include normal saline for sodium and water replacement during resuscitation, compound sodium lactate for electrolyte balance and water replacement, and albumin for edema and resuscitation. The appropriate fluid depends on the patient's needs and condition.
Fluids
- 2. The (fictional) normal 70kg white male? • How much water? • What else is does he contain? • What else is in his blood?
- 5. 42 litres!
- 6. What is your water volume OUTSIDE the cells (extracellular volume)?
- 7. 15 litres
- 8. What is your blood volume?
- 9. 5-6 litres
- 10. What is your PLASMA volume?
- 11. 3 litres
- 12. 42 litres total 15 litres EC 3 litres plasma
- 15. Daily fluid requirement? • How much? • What type of fluid?
- 16. Intake
- 17. Output
- 18. Others • “Third Space” losses • Insensible losses
- 20. In the cell Outside the cell
- 21. In the cells Outside the cells
- 22. Our main concerns are…
- 23. The aim is to match input and output (for water, Na+, K+) Oral + IV = Urine + Vomiting/NG + Bleeding + Insensible
- 24. What fluid to use?
- 27. TASTE TEST
- 29. 5% Glucose • Glucose – 50g • Water – 1000ml • “free water”
- 30. 42 litres total 14 litres EC 3 litres plasma
- 31. 5% Glucose • Good for… – High Na+ – Glucose infusion • Bad for… – Blood pressure
- 32. 4% Glucose + 1/5 N saline • Glucose – 50g • Na+ - 30mmol • Water – 1000ml • “free water”
- 33. 42 litres total 14 litres EC 3 litres plasma
- 34. 4% Glucose + 1/5 N saline • Good for… – High Na+ – Glucose infusion • Bad for… – Blood pressure
- 35. Normal Saline • Contains (mmol): • Na+ 150 • K+ 0 • Cl- 150 • Water 1000ml
- 36. 42 litres total 14 litres EC 3 litres plasma
- 37. Normal Saline • Good for… – Na+ replacement – Water replacement – Resuscitation • Bad for… – K+ replacement – Other electrolytes – Acidosis
- 38. Compound Sodium Lactate (CSL, Hartmann’s Solution) • Contains (mmol): • Na+ 129 • K+ 5 • Cl- 109 • Ca2+ 2 • Lactate 29 • Water 1000ml
- 39. 42 litres total 14 litres EC 3 litres plasma
- 40. Compound Sodium Lactate (CSL, Hartmann’s Solution) • Good for… – Na+ replacement – Electrolyte balance – Water replacement – Resuscitation • Caution with… – Liver failure
- 42. …a word about potassium… • Daily potassium requirement – 100mmol • It all depends – Intake (IV or oral) – Output (stoma, URINE, NG losses)
- 44. Potassium (mmol) • Chlorvescent – 14 • Slow K – 8 • Normal Saline – 0 • CSL / Hartmann’s – 5 • CSL+KCl – 30 • Albumin, 5% Glc - 0
- 45. Compound Sodium Lactate + KCl (Hartmann’s Solution + KCl) • Contains (mmol): • Na+ 129 • K+ 30 • Cl- 134 • Ca2+ 2 • Lactate 29 • Water 1000ml
- 46. 42 litres total 14 litres EC 3 litres plasma
- 47. Compound Sodium Lactate + KCl (Hartmann’s Solution + KCl) • Good for… – Na+ replacement – K+ replacement – Electrolyte balance – Water replacement – Maintenance • Caution with… – Liver failure
- 48. Albumin 4% • Contains – Human albumin 20g – Water 500ml – Na+ 75 – Cl- 75 – Good for oedema – Fluid resus
- 49. 42 litres total 14 litres EC 3 litres plasma
- 50. Albumin 20% • Contains – 20g albumin – 100ml water • Good for – Resuscitation – Oedema
- 51. OTHERS • FFP • Cryoprecipitate • Red Blood Cells • Platelets • Starches (gelofusin, voluven)
- 52. 42 litres total 14 litres EC 3 litres plasma
- 53. What fluid? - Summary • Type of fluid depends on the patient • If they are bleeding give blood and blood products • Resuscitation
- 54. What fluid? Summary Resuscitation Fluid • Normal Saline • CSL • Albumin 4%
- 55. What fluid? Summary Maintenance • CSL or CSL+KCl • Always add potassium UNLESS there is a good reason not to. • 4% + 1/5 NS a reasonable alternative