FLUID AND ELECTROLYTE Part 1 Repersented by Dr

FLUID AND ELECTROLYTE Part -1 Repersented 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 weight This can be 70% or higher in a new born. Total Body Fluid can be divided into Intracellular and Extracellular

INTRACELLULAR FLUID � 20 LITER 2/3 OF THE TOTAL BODY WATER. � FOUND INSIDE THEPLASMA CELLS. MEMBRANE OF THE BODY'S

Extracellular Fluid 10 liter -1/3 of the TBW, either: Ø Plasma ¼( 2. 5) liter Ø Interstitial fluid 7. 5 liter Interstitial, Intravascular and 3 rdspace 1 -Interstitial compartment • It the small, narrow spaces between tissues or parts of an organ. It is filled with what is called interstitial fluid • When excessive fluid accumulates in the interstitial space oedema develops.

EXTRACELLULAR FLUID THIRD SPACE • The 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, Post cardiac arrest, hypoxia. gastrointestinal surgeries.

Water requirements increase with: • Fever Sweating • Burns Tachypnea • Surgical drains Polyuria • Gastrointestinal losses through Vomiting or diarrhoea � Water requirements increase by 100 to 150 m. L/day for per degree Celsius of body temperature elevation.

Types of Fluid The fluids can be classified into crystalloids, colloids and blood products 1. Crystalloids 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 It liter contains 50 gm of glucose. 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 oedema Ø Never mix dextrose with blood as it causes blood to haemolyse. Ø Not used for resuscitation, because the solution won't remain in the intravascular space. Ø 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 m. Eq each of sodium and chloride INDICATION To treat hypovolaemia, as in fluid volume deficit from Haemorrhage - Severe vomiting or diarrhoea - Heavy drainage from GI suction, intestinal fistulas, or wounds Shock Mild hyponatremia, hypercalcaemia Metabolic acidosis (such as diabetic ketoacidosis), alkalosis It’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% Na. Cl) Indication. Hypovolaemia, hyponatraemia Alkalosis 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 solution Indication It 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. 4. Diabetic ketoacidosis it provide glucose free fluid. 5. Patients experiencing acute blood loss or hypovolemia due to third-space fluid shifts. 1. 2. 3.

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 lactate RL and blood not infused simultaneously. Blood precipitate due to calcium. RL shouldn't be given to a patient whose p. H is greater than 7. 5

ISOLYTE-M (MAINTENANCE) INDICATION Rich potassium in it is useful in correcting the hypokalemia. It is used in acidosis also. Used in diarrhoea, bilious vomiting. CONTRAINDICATION Not used to correct hyponatraemia as sodium concentration is low in it.

ISOLYTE-G (Gastric) INDICATION Gastric juice vomiting Nasogastric aspiration Metabolic alkalosis

ISOLYTE-E (Extracellular replacement) INDICATION It used mainly to replace extracellular fluid. CONTRAINDICATION Not used in metabolic alkalosis due to vomiting or due to diuretic.

ISOLYTE-P (Pediatric) INDICATION Used in fluid therapy in paediatric age group CONTRAINDICATION Not used to correct hyponatraemia, renal failure, hyperkalaemia, hypovolaemic shock.