FLUIDS

Types of fluids:
Crystalloid Colloid
- Small ionic molecules - Big organic molecules
 Normal Saline (NS) [NaCl]  Albumin/gelofusion etc
 Hartmann’s
 (Salty fluid)
 5% Dextrose (D5W)  Packed Red Blood Cells (PRBC)
 (Water)  Fresh Frozen Plasma (FFP)
 Platelets
 (Blood products)

Fluid in our body:

ECF Vasc
(33%) 1/12 of body water is in blood
25%
vessels

H2O ICF

(60-65%) (66%)

Three distributions:
1. Only vascular  colloids
2. ECF only  NS & Hartmann’s
3. All water  D5W
a. Liver uptakes all the dextrose on first pass.
b. We cannot give pure water to patients (osmolarity); will cause blood cells to POP!

Maintenance of body requirements for oral fluids via:

1. Thirst mechanism
2. Access to water
3. Physical ability to drink water.

Therefore, if the patient is unable to do one of these things, we need to think of giving them IV
fluids.
How much water do we need?

Calculation:

 4ml/hour for the first 10kg.

This helps us to calculate how fast/the
 2ml/hour for the next 10kg.
rate.
 1ml/hour for the remaining weight.
 If weight is > 20kg = (W +40)ml/hour.

Alternatively,

 100ml/day for the first 10kg.

This helps us to calculate much fluid
 50ml/day for the next 10kg.
that is needed a day.
 25ml/hour for the remaining weight.
 (=25ml/kg/day + 1L)

Na+ requirements
Steps to calculate fluids:
 We need 1 – 2 mmol/kg/day.
 1L NS 1. ml/hour of water
o Body = 330 mOsm/L. 2. 24/24 water
o Therefore, 1L NS =330mOsm/L of NaCl. requirements
o Thus, Na+ = 165mOsm/L and Cl- = 165mOsm/L
3. Na+
K+ requirements 4. K+
 We need 0.5 – 1 mmol/kg/day. 5. Write orders
 Hartmann’s contain 5.1 mmol/L.

Examples:
1. 23 year old male who weighs 80kgs is unconscious. Calculate 24/24 fluids.

Firstly, how much water does he need?

= (80 + 40) ml/hour
= 120 ml/hour or 2500ml/day

Secondly, how much Na+ and K+ does he need?

Based on the formula above, he needs:

 Na+ = 80 160 mOsm/L

 K+ = 40-80 mOSm/L

Fluid Rate Additionals

NS 120ml/hour 30 K+
D5W 120ml/hour 30 K+
D5W 120ml/hour
Note:

 Amount of K+ added lies between the range of requirements.

 Can’t put all the K+ in one go as it can lead to hyperkalaemia. This can cause arrhythmias,
such as ventricular tachycardia.
 Rate of K+ that is safe to be used on wards is approx. 5 mOsm/hour. With monitoring (live
ECG) it is safe to go up to 10 mOsm/hour.
 Standard amount used for K+ is in increment of 20 mOsm/L.

2. 40kg little old lady has deteriorated post-hernia repair. Calculate her 24/24 IV fluid
requirements.
 Water = 80ml/hour or 2L/day
 Na+ = 40-80
 K+ = 20-40

Fluid Rate Additionals

NS 80ml/hour 20 K+
D5W 80ml/hour 20 K+

Fluid homeostasis:
In Out
1500ml drink 1500ml wee
5-900ml food Unknown amount in sweat
400ml faeces
5-500ml insensible loss (eg: respiratory)

 In people who are NOT nil by mouth (i.e still eating), we will give them less 5-900ml of fluid
(based on the table above).
 Fluid balance chart is almost always positive (+) 5-900ml because it does not calculate fluid
loss apart from wee.
o Therefore, in order to get a more accurate fluid balance, daily weigh is important.
o Daily electrolytes is also important to make sure that the fluids given is sufficient.