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Fluid & Electrolytes - Lebbie
Fluid & Electrolytes - Lebbie
AIAH LEBBIE
M.B.CH.B
FCS (ECSA)
Welcome!
Approximately 2/3
of the body weight
is water. The
Total
Body 2/3 of percentage is
Water total somewhat higher in
body children
weight
Body Fluid Compartments
Approximately
2/3 of the total
Intra- body water is
cellular found within the
2/3
cells and 1/3 is
outside of the
cells.
Extra-
cellular 1/3
Body Fluid Compartments
Intra-
cellular
2/3
Inter-
stitial 2/3
Extra-
cellular 1/3
Intra- 1/3
vascular
Total body water
2/3 -1/3 rule
Intra-
cellular
2/3 (40%)
Inter-
stitial 2/3 (13%)
Extra-
cellular 1/3 (20%)
Intra- 1/3 (7%)
vascular
Total body water
Application of the 2/3 – 1/3
rule…
Total Body Water – 66%
Intra-
cellular
2/3 (44%)
Inter-
stitial 2/3 (14%)
Extra-
cellular 1/3 (22%)
Intra- 1/3 (7-8%)
vascular
Total body water
Intracellular and Extracellular
Ions
Intracellular Extracellular
K +
Na+
K+
Cl- PO = 4
Mg++
Na+
Mg++ Cl -
PO =
SO
4
=
4
Proteins
Comparison of Intracellular and
Extracellular Ion Concentrations
Intracellular Extracellular
Sodium 10 mEq/l 142 mEq/l
Potassium 150 4
Magnesium 40 2.5
Chloride 0 103
Phosphates 150 3
& Sulfates
Proteins 16 40
Extracellular Ions
2/3 – 1/3
100
50
20
Estimated water needs -
adults
For healthy adults: 35 - 40 cc/kg/day
For older adults or with limited ability to
handle fluids: 30-35 cc/kg/day
2/3 – 1/3
100 – 50 – 20
35-40
30-35
Newborn Fluid Requirements
Term Neonate
DOL 1:
50-60mL/kg/d
DOL 2:
100mL/kg/d
>7d:
100-150mL/kg/d
Unstressed neonates require
less fluid
Pediatrics: 2 - 3 mEq/kg/day
VLGA/critically ill : 4-5mE/kg/day
Adults: 1 - 2 mEq/kg/day
Examples: 14 kg. toddler
14 kg x (2 - 3 mEq/kg/d) = 28 - 42 mEq/d
60 kg. adult
14 kg x (1 - 2 mEq/kg/d) = 14 - 28
mEq/d
60 kg. adult
Calcium requirement
0.5 – 3 mEq/kg/d
Replace, especially in premies
Immature renal and parathyroid function
Small bone reserves
All sick neonates: 2gm Ca gluconate/500cc
1gm CaGluc = 4.65mEq Calcium
3.0kg, 3d/o: 300mL/d 5.6mEq/d
Your New Mantra
2/3 – 1/3
100 – 50 – 20
35-40
30-35
2-3 & 1-2
1-2 and .5 – 1
0.5-3
Example for 14 kg. Child
Sodium:
14 kg x (2 - 3 mEq/kg/d) = 28 - 42 mEq/d
Potassium:
14 kg x (1 - 2 mEq/kg/d) = 14 - 28 mEq/d
2/3 – 1/3
100 – 50 – 20
35-40
30-35
2-3 & 1-2
1-2 and .5 – 1
0.5-3
End of Section 2
Sodium:
14 kg x (2 - 3 mEq/kg/d) = 28 - 42 mEq/d
Potassium:
14 kg x (1 - 2 mEq/kg/d) = 14 - 28 mEq/d
2/3 – 1/3
100 – 50 – 20
35-40
30-35
2-3 & 1-2
1-2 and .5 – 1
308 – 275
Dextrose in water
2/3 – 1/3
100 – 50 – 20
35-40
30-35
2-3 & 1-2
1-2 and .5 – 1
308 – 275
3.4
Composition of Intravenous Fluids
H20
H20
H20
Why not use hypotonic
fluids?
Hypotonic fluids cause fluid shifts resulting in
lysis of red cells
H20
H20
H20
Why not use hypotonic
fluids?
Hypotonic fluids cause fluid shifts resulting in
lysis of red cells
H20
H20
H20
Why not use hypotonic
fluids?
Hypotonic fluids cause fluid shifts resulting in
lysis of red cells
Composition of Intravenous Fluids
2/3 – 1/3
100 – 50 – 20
35-40
30-35
2-3 & 1-2
1-2 and .5 – 1
0.5-3
308 – 275
3.4
Choosing the right IV fluid
Na+ Cl- K+ HCO3= Ca++ mOsm Kcal
0.9
Normal 154 154 - - - 308 -
saline mEq
0.45 NS 77 77 - - - 154 -
0.2 NS 34 34 - - - 68 -
D5W - - - - - 275 170
D5W/.45 77 77 - - - 429 170
NS
Ringer’s 130 109 4 28 2.7 274 -
(as
lactate lactate)
100-50-20
30-35; 35-40
Salivary 1500 10 26 10 30
(500- (2-10) (20-30) (8-18)
2000)
Salivary 1500 10 26 10 30
(500- (2-10) (20-30) (8-18)
2000)
Na+ Cl- K+ HCO3= Ca++ mOsm Kcal
0.9
Normal 154 154 - - - 308 -
saline mEq
0.45 NS 77 77 - - - 154 -
0.18 NS 31 31 - - - 62 -
D5W - - - - - 275 200
D5W/.18 31 31 - - - 337 200
NS
Hartman’s 131 114 5.4 28 3.7 279 -
solution (as
lactate)
Composition of GI Fluids --
Saliva
Volume Na (mEq/l) K (mEq/l) Cl HCO3
(cc/24hrs) (mEq/l) (mEq/l)
Salivary 1500 10 26 10 30
(500- (2-10) (20-30) (8-18)
2000)
Na+ Cl- K+ HCO3= Ca++ mOsm Kcal
0.9
Normal 154 154 - - - 308 -
saline mEq
0.18 NS 31 31 - - - 62 -
- - Plus 30 mEq of 335 200
D5W K2HCO3 if available
or 30 mEq of or
Na2HCO3 plus 20 375
Meq KCl
Composition of GI Fluids -
Gastric
Colon Variable 60 3 40 -
Malnourishment
Expected to remain NPO > 5 - 7 days
Requirements are greater than can be
voluntarily consumed
Chemotherapy/radiation therapy
Hyperalimentation -
Nitrogen Balance
100-50-20
30-35; 35- 40
Altogether now ….
Mantra #2
And number 1
again…. 100-50-20
30-35; 35-40
Composition of Intravenous Fluids