Maintenance Fluid Therapy

FLUID THERAPY

RESUSCITATION MAINTENANCE

Crystalloid Colloid ELECTROLYTES NUTRITION

1. Replace acute loss 1. Replace normal loss

(hemorrhage, GI loss, (IWL + urine+ faecal)
3rd space etc) 2. Nutrition support
 Deficit
.
Dehydration Hypovolemia

* thirst • headache
* urine output  • nausea
• syncope

hypotonic isotonic
electrolytes electrolytes

Ringer lactate Ringer’s acetate

5% Dextrose Ringer’s lactate
N/2-D5 Normal saline
 BODY FLUIDS COMPARTEMENT

NORMAL FLUID DITRIBUTION

40%

PERCENT
OF BODY
WEIGHT

EXTRA CELL
20%

INTRA CELL INTERSITIEL INTRAVASCULAR

 BODY FLUIDS COMPARTEMENT

40%

PERCENT
OF BODY
WEIGHT

20%

DIARRHEA

INTRA CELL INTERSITIEL INTRAVASCULAR

 BODY FLUIDS COMPARTEMENT

CRITICALLY ILL PATIENTS

40%

PERCENT
OF BODY
WEIGHT

THIRD
20%
SPACE

INTRA CELL INTERSITIEL INTRAVASCULAR

 Fluids can be described as being
.
from three categories
Isotonic - Fluid has the same osmolarity as plasma
Normal Saline (N/S or 0.9% NaCl),
Ringers Acetate(RA), Ringer’s lactate (RL)

Hypotonic -Fluid has fewer solutes than plasma

Water, 1/2 N/S (0.45% NaCl), and D5W
(5% dextrose in water) after the sugar is
used up

Hypertonic-Fluid has more solutes than plasma

5 % Dextrose in Normal Saline (D5 N/S),
3% saline solution, D5 in RL.Koloid.
 Isotonic Dehydration
Most Common form of Dehydration

Occurs when fluids and electrolytes are lost in

even amounts

There are no intercellular fluid shifts in

isotonic dehydration

Common Causes
diuretic therapy
excessive vomiting
excessive urine loss
hemorrhage
decreased fluid intake
 Hypertonic Dehydration
Second most common type of dehydration.

Occurs when water loss from ECF is greater than

solute loss

hyperventilation, pure water loss with high fevers,

and watery diarrhea.

Diabetic Ketoacidosis and Diabetes Insipidus

Iatrogenic Causes
prolonged NPO, excessive hypertonic fluids, sodium
bicarbonate, or tube feedings with inadequate water
 Hypotonic Dehydration
Relatively Uncommon - Loss of more solute
(usually sodium) than water.

Hypotonic Dehydration causes fluid to shift from the

blood stream into the cells, leading to decreased
vascular volume and eventual shock
Seen in Heat Exhaustion

Increased cellular swelling -causes increased

intracrainial pressure - H/A and Confusion.
Seen in Heat Stroke
 Isotonic infusion
• Ringer’s acetate
• Ringer’s lactate
• Normal saline

Replace acute/
increases ECF abnormal
loss

ICF ISF Plasma

800 ml 200 ml
 Hypotonic infusion
• 5% dextrose

Replace Normal
increases ICF > ECF loss (IWL + urine)

ICF ISF Plasma

660 ml 255 ml 85 ml
 Fluid Therapy

• Replacement
• Maintenance
• Repair deficit
 BACIC PRINCIPLES

Replace Abnormal loss: GIT, 3rd space,

Ongoing loss, septic and
Hypovolemic shock

Maintain IWL + urine

Repair Acid base, electrolyte imbalances

 FLUID SELECTION
• Replace : RA, RL, NS
• Maintain: N/2 + D (adult) + K+ 20 mEq
N/4 + D (children) + K+ 20 mEq
Ringer lactate, Ringer Acetate
• Repair : NaHCO3 8,4%
KCl 25 mEq/25 ml
NaCl 3%
 Estimating maintenace fluid requirements

Weight Rate

For the first 10kg 4cc/kgBW/h

For the next 10 - 20 kg Add 2cc/kgBW/h

For each kg above10kg Add 1cc/kgBW/h

Morgan, G E, clinical
Anesthesiology 2nd Ed 1996
 Maintenance
• IWL + urine
• Adults/children : 4:2:1
eg 60 kg 4 x 10 + 2 x 10 + 1 x 40 =
100ml/hr
ESTIMATED FLUID LOSSES
• Measurable ( normal/abnormal)
Bleeding, diuresis, gastrointestinal. And losses trough
drain

• Unmeasureable :
- Insensible water losses (IWL)
1. Through the lung 0 - 8 cc/ kgBW/day.
2. From the skin
3. Surgical trauma / open wound

- Sequesterisation ( third space losses)

Fluid intake/Output in Normal patients (70kg)

Water intake : 1400 -1500 cc

food : 700 - 1000 cc 2400 -3200
oxydation : 300 - 400 cc

Urine : 1400 - 1800 cc

Feces : 100 cc
2400 - 3200
Skin : 300 - 500 cc
Lung : 600 - 800 cc
 Requirements
• Fever
• Restless/delirium
• Warm ambient temperature
• Hyperventilation
 Requirements
• Hypothermia
• High humidity
• Oliguria/anuria
• Reduced consciousness
• Retention/oedema
• Increased intracranial pressure
Thank U