Fluid

Therapy

Six Questions to Answer
1. When should fluid therapy be instituted?
2. What kind of solution should be used?
3. How much fluid should be administered?
4. How fast should the solution be given?
5. What route of administration should be used?
6. How will the success of Fluid therapy? (to be evaluated)


1. When should fluid therapy be instituted?
• Correcting dehydration, over hydration and electrolyte imbalance.
• To correct condition of Acidosis, Alkalosis and shock.
• To give parenteral nourishment and stimulate organ function.

2. What kind of solution should be used?
a. Metabolic Acidosis – Diarrhea and Poisoning
b. Respiratory Alkalosis – Pneumonia and Pulmonary problems
Use: 5% dextrose with H2O, LRS, NaHCO3 and Na glucomate

c. Metabolic Alkalosis – Vomiting and over used of diuretics
d. Respiratory Acidosis – Fever and Hyperventilation
Use: Ringers solution, NSS with NaCl and NH4Cl

3. How much fluid should be administered?
a. MD = Formula: Body weight x Normal water turn-over
§ Young and Lactating – 130ml/kg/day
§ Adult – 65ml/kg/day

b. RD = Formula x % Dehydration
§ 4% or less
- History of fluid loss
- Mucous membranes still moist
- Evidence of thirst

§ 5% - 6%
- Subtle loss of skin elasticity
- Slight delay in return of skin to normal position
- Hair coat dull
- Mucous membranes slightly dry
- Tongue still moist


§ 7% - 8%
- Definite delay in return of skin to normal position
- Both mucous membranes and tongue may be dry
- Eyeballs may be soft and sunken
- Slight prolongation of capillary refill time

§ 9% - 11%
- Tented skin does not return to normal position
- Definite prolongation of capillary refill time
- Eyes definitely sunken in orbits
- All mucous membranes dry
- May be signs of shock such as tachycardia
- Cool extremities
- Rapid and weak pulses

§ 12% - 15%
- Definite signs of shock
- Circulatory collapse
- Death is imminent

c. CL = Given

4. How fast should the solution be given?
o Macro drip – 15 drops/min
o Micro drip – 60 drops/min

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Formula: = Answer/60mins
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5. What route of administration should be used?
§ Oral or Nasogastric
§ Per rectum (for 1st week of newborn ONLY)
§ Intravenous
§ Subcutaneous
§ Intraperitoneal (For Large and Laboratory animals)

6. How will the success of Fluid therapy? (to be evaluated)
- Based on the clinical judgment





Types of IV fluids
1. Colloid
2. Crystalloid
3. Blood products


ISOTONIC – Equal concentration of solution.
Fluid Types
• 0.9% saline
• 5% Dextrose in water (D5W)
• 5% Dextrose in 0.225 saline
• Lactated ringers

Why are they used:
• To increase extracellular fluid volume loss through:
• Blood loss
• Dehydration (Diarrhea and vomiting)
• Surgery

HYPOTONIC – Low concentration of solution
Fluid Types
• 0.45 % Saline (1/2 NS)
• 0.225 % Saline (1/4 NS)
• 0.33 % Saline (1/3 NS)

Why are they used:
• Used when cell becomes dehydrated

HYPERTONIC – High concentration of solution
Fluid types
• 3% Saline
• 5% Saline
• 10% Dextrose in water
• 5% Dextrose in 0.9% saline
• 5% Dextrose in 0.45% saline
• 5% Dextrose in LR

Why are they used:
• Hypernatremia
• Cerebral edema