Principles of Fluids and

Electrolytes: Management
Victor S. Doctor, MD, FPPS, FPSN, FPNSP
 NORMAL

300

300
300

CELLS BLOOD GIT

 NORMAL

300

300
300
 NORMAL

300

300
300
 NORMAL

300

300
300
 NORMAL

300

300
300

Urine Stools
 DIARRHEA

300

300
300
 DIARRHEA

300

300
300
 DIARRHEA

300

300
300
 DIARRHEA 255

300

300
300
 DIARRHEA
255

300

300
300
 DIARRHEA
255

300

300
300
 DIARRHEA
255

300

300
300
 DIARRHEA
255

300

300
300
 DIARRHEA = SEVERE

300

300
300
 DIARRHEA = SEVERE

300

300
300
 DIARRHEA = SEVERE

300

300

300
300
 DIARRHEA = SEVERE

300

300

300
300
 DIARRHEA = SEVERE

300

300

300
300
 DIARRHEA = SEVERE

300

300

300
300
PLASMA LEAK SYNDROMES

300

300
PLASMA LEAK SYNDROMES

300

300
PLASMA LEAK SYNDROMES

300

300
 PLASMA LEAK SYNDROMES

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

300

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

300

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

300

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

300

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

300

Oliguria
↓BP
300

300
 Management with NSS

pH Na K Cl HCO3 Osm

PLASMA 7.4 140 4 109 27 300

NSS 5.5 154 0 154 0 308

 PLASMA LEAK SYNDROMES

274

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

274

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

274

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

274

Oliguria
↓BP
300

300
 PLASMA LEAK SYNDROMES

274

Oliguria
↓BP
300

300
 pH Na K Cl HCO3 Ca Osm
PLASMA 7.4 140 4 109 27 2 300
LRS 6.5 130 4 109 28 2 274
NSS 5.5 154 0 154 0 0 308
BEL 7.4 140 4 109 27 2 290
 When to give D5
After Resuscitation (20 minutes)
Hydration D50.3% NaCl Diarrhea
4 - 8 hours D5LRS
Dengue, etc.
D5NSS
After Hydration
Maintenance D5IMB
Diarrhea
D5NM
16 - 24 hours D5LRS Dengue, etc.
D5NSS Dengue, etc.
 Frequency of Assessment
Duration Volume Solution

PLRS
I. Resuscitation 20 minutes 20
PNSS
II. Hydration
50
Diarrhea 4-8 hours 100 D50.3% NaCl
150
90 (7-11)
1-2 hours D5LRS
Dengue 60 (5-7)
2-4 hours D5NSS
30 (3-5)
III. Maintenance
Diarrhea 16-24 hours 100 D5IMB/D5NM
Dengue 2-4 hours 75 (2-3) D5LRS/D5NSS
 PLAIN ISOTONIC SOLUTIONS
FOR RESUSCITATION
pH Na K Cl HCO3 Ca Osm Gluc BUN D5 mOsm

PLASMA 7.4 140 4 109 27 2 300 80 14

5000
LRS 6.5 130 4 109 28 2 274 0 0 → 567
(277)
5000
NSS 5.5 154 0 154 0 0 308 0 0 → 577
(277)

BEL 7.4 140 4 109 27 2 290 0 0

 Osm pH Na K Cl HCO3 Ca Mg PO4 Glucose BUN

7.4 140 4 109 27 2 1.2 2 80-100 12-14

PLASMA 280-300 = + +
2(Na) 18 2.8

7.4 140 4 109 27 2 1.2 —

BEL 290 = + 0 + 0
2(Na)

6.5 130 4 109 28 2 0 0

LRS 274 = + 0 + 0
2(Na)

5.5 154 0 154 0 0 0 0

NSS 308 = + 0 + 0
2(Na)

1. Choose better survival (vascular resuscitation)

2. Choose improved survival (vascular + cellular resuscitation)
Glucose BUN
280-300 = 2Na(Vascular compartment) + +
18 2.8
Cellular
Circulation
Compartment

BP LIFE
Thank You