FLUID MANAGEMENT

Clinical ph.
Abdullah A. Dawood
 Distribution of total body fuid (TBF)

60% Intracellular F.
40% Extra cellular F.
 Distribution of intravenous fluid

IV fluid volum (ml) equivalent IVvolum (ml)

N.S. 1000 250

R.L. 1000 250

G.W.5% 1000 100

Albumin 5% 100 100

Albumin 25% 100 500

 Intravascular Volume Depletion
Tachycardia (HR > 100 beats/minute)
Hypotension (SBP < 80 mm Hg)
Orthostatic changes in HR or BP
Increased BUN/SCr ratio > 20:1 Causes
Dry mucous membranes Because of shock (hypovolemic or septic shock),
Decreased skin turgor when about 15% (750 mL) of blood volume is lost
Reduced urine output
Dizziness
Improvement in HR and BP after a 500- to 1000-mL fuid bolus

Fluid Resuscitation
 The goal of fluid resuscitation is
-to restore intravascular volume
-to prevent organ hypoperfusion.

Intravenous fuids are administered as a

500- to 1000-mL bolus, (~30 mL/kg in septic patients)
after which the patient is reevaluated; This process is continued as
long as signs and symptoms of Intravascular volume depletion
are improving
 in Hypovolemia

Lactated Ringer solution is historically

preferred in surgery and trauma patients,
but no evidence suggests superiority
over N. in these settings

R.L. metabolized to bicarbonate,

useful for metabolic acidosis
 Maintenance intravenous fuids

• indicated in patients who are unable to tolerate oral fuids

• The goal of maintenance intravenous fuids is to prevent dehydration
• The identical maintenance intravenous fuid is
D5 W with 0.45% sodium chloride
plus 20–40 mEq of KCl per liter

For adults
Administer 20–40 mL/kg/day (for adults only).
Pediatric
Administer 100 mL/kg for frst 10 kg, followed by 50 mL/kg
for the next 10–20 kg (i.e., 1500 mL for the frst 20 kg)
plus 20 mL/kg for every kilogram greater than 20 kg

10 Kg 1 L

20 Kg 1.5 L

30 Kg 1.7 L