Scribd
Upload
101 views16 pages

Fluid and Electrolytes - 1

Maintenance of fluids and electrolytes is important. Water requirements can be calculated based on caloric expenditure and losses through urine, feces, lungs, and skin. Sodium and potassium losses in urine are also considered. Oral rehydration solutions like WHO ORS are effective for mild to moderate dehydration while intravenous fluids like saline are used for more severe cases. The degree and type of dehydration (isotonic, hypotonic, or hypertonic) determines the fluid and electrolyte deficits and guides appropriate treatment and rate of replacement. Care must be taken with hypertonic dehydration to lower sodium levels slowly and prevent fluid shifts causing edema.

Uploaded by

api-19641337
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
101 views16 pages

Fluid and Electrolytes - 1

Maintenance of fluids and electrolytes is important. Water requirements can be calculated based on caloric expenditure and losses through urine, feces, lungs, and skin. Sodium and potassium losses in urine are also considered. Oral rehydration solutions like WHO ORS are effective for mild to moderate dehydration while intravenous fluids like saline are used for more severe cases. The degree and type of dehydration (isotonic, hypotonic, or hypertonic) determines the fluid and electrolyte deficits and guides appropriate treatment and rate of replacement. Care must be taken with hypertonic dehydration to lower sodium levels slowly and prevent fluid shifts causing edema.

Uploaded by

api-19641337
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 16

Fluids and electrolytes

Maintenance:
Can be calculated from caloric expenditures

Maintenance water requirements:


Determined by water lost from feces and urine
and insensible losses (ie, losses through the lung
and skin)
Fecal losses are minimal
100 ml for each 100 Kcal expended may be used
when calculating insensible and renal water
losses
Na+ lost daily in the urine: 2-3 meq/kg
K+ lost daily in the urine: 1-2 meq/kg

Maintenance done as following:


•0 – 10 Kg:
100 ml/kg
•11 – 20 kg:
1000 ml + 50 ml/kg for each kg > 10 kg
•>20 kg:
1500 ml + 20 ml/kg for each kg > 20 kg
Plasma Osmolality
mOsm/kg

= 2 (Na, meq/l) + glucose, mg/dl + BUN, mg/dl


18 2.8
•Isonatremic (isotonic ):
Na is 130 – 150 meq/l with proportional losses of
fluid and electrolytes from the extracellular space

•Hyponatremia (hypotonic): Na < 130 meq/l; lose


more Na than water

•Hypernatremic (hypertonic): Na >150 meq/l; lose


more water
•Deficit from extracellular and intracellular fluid
compartments
History
Physical exam
Lab tests

Degree of dehydration:
Mild Moderate Severe
Infants 5% 10% 15%
Adolescents 3% 6% 9%
Assessment of degree of dehydration:

Mild Moderate Severe


•Isotonic fluids such as normal saline or
lactated Ringer’s should be used for
volume resuscitation

•Oral rehydrating solutions (ORS)


•WHO ORS
•Successful in mild to moderated dehydration
Composition of WHO oral rehydration
solution
Advantages of 2002 formula have been quoted
as:

- lower osmolality allows quicker absorption of


fluids

- less chances of hypernatremia

- more stability of reconstituted solution

- decreased number of hospitalizations

- less cost of manufacturing


Typical Electrolyte Compositions of Various
Body Fluids
  Na+ K+ HCO3–
(mEq/L) (mEq/L) (mEq/L)
     
Diarrhea 10–90 10–80 40
Gastric 20–80 5–20 0
Small intestine 100–140 5–15 40
Ileostomy 45–135 3–15 40
Estimated Water and Electrolyte Deficits in
Dehydration (Moderate to Severe)

Type of H2O Na+ K+ Cl– and HCO3–


Dehydration (mL/kg) (mEq/kg) (mEq/kg) (mEq/kg)
       

Isotonic 100–150 8–10 8–10 16–20


Hypotonic 50–100 10–14 10–14 20–28
Hypertonic 120–180 2–5 2–5 4–10
Therapy

Re-evaluate

Total volume = Deficit + Maintenance + Ongoing

losses

When the child presents in hopovolemic shock,


rapid volume expansion is needed
Therapy (Contd…)

Intavenous bolus of 20 ml/kg of isotonic fluid


given

After the bolus, patient reassessed , and second


bolus of isotonic solution may be given

Subsequent therapy should be aimed at


correcting the factors contributing to the
hypovolumic shock
Therapy
Isotnatremic dehydration
Deficit should be replaced over 8 – 24 h

Hyponatremic dehydration
Deficit should be replaced over 8 – 24 h

Severe hyponatremic dehydration, Na may be


given as a 3% Nacl solution

Amount of Na (meq) that can be given as 3%


= (Desired Na – current Na) X
Body weight in Kg X 0.6
Hypertonic dehydration:

•Deficit should be replaced over 48 h


•Prevents fluid shifts into the cells
•A rapid decrease in serum Na decreases serum
osmolality faster than intracellular osmolality, and
fluid goes into the cells, resulting in edema
•Na should be lowered no faster than 10 meq/l/d

You might also like