Curso Manejo del

paciente crtico con

prcticas
de
Balance Hdrico
conceptos
bsicos
Simulacin

DR JORGE CERNA BARCO

DRA OLGA FAJARDO

DISTRIBUCIN DEL AGUA CORPORAL

TOTAL SEGN COMPARTIMIENTOS
Compartimientos

% Peso Corporal

Agua plasmtica

4%

Agua intersticial

16 %

Agua
total
Agua

extracelular

20 %

intracelular

40 %

Promedio total de Agua

Hombre

60 %

Mujer

50 %

REQUERIMIENTO BASALES DE FLUIDOS Y

ELECTROLITOS
( INGRESOS )

1. Volumen 40 ml /kg/ 24 horas o 1800 a 2500 ml/ 24 h

2. Electrolitos: Sodio
12 mEq
( 1- 3 ) gr.

Potasio
Magnesio
40 - 150
40 - 80
8 (5 - 9)
(4-5)

3. Agua metablica, produce en:

* Paciente 70 kg. no hipercatablico : 300 ml
* Paciente 70 kg. hipercatablico

: 600 1000 ml

BALANCE HIDROELECTROLITICO
EGRESOS

1. Prdidas insensibles ( piel y pulmones ): 15 ml/kg/24 h

Condiciones anormales:
a) Hiperventilacin: incrementa 100 ml. Por c/5 resp./24 h
b) Fiebre: incrementa en 150 ml./grado temp./24 h
c) Sudor: ( 24/h )
vol.
Sodio cloro
potasio
*
Moderado e intermitente 500 ml 25 mEq 25 mEq 7 mEq *
Moderado continuo
1000 50
50
14
*
Profuso
2000 100 100
28
*

2. Prdidas urinarias
* volumen: 0.5 1.0 ml/kg/hora . En
adulto 70 kg.: 1000 a 1500 ml/24 horas.
* Contenido de electrolitos:
Sodio: 40 80
mEq/L
Potasio: 40
80 mEq/L
Cloro : 60
120 mEq/L
3. Prdidas en heces
* Volumen : 200 ml
* Contenido electrolitos:
Sodio : 20 mEq
Potasio : 45 mEq
Cloro : 15 mEq

FLUIDOTERAPIA
PERIOPERATORIA
Microlaparatomia

50 ml/hora
Abdomen abierto 100 ml/hora
Torax abierto
150 ml/hora

54

Intravascular Fluid and Electrolyte Physiology

Alan D.Kaye, James M.Riopelle Puntos claves
1. Water is the major component of all fluid compartments
within the body and represents approximately 60% of body
weight.

2.Sodium is the most abundant positive ion of the

extracellular fluid (ECF) compartment and is crucial in
determining the extracellular and intracellular osmolality.

3.Potassium is the most abundant positive ion in the

intracellular fluid and plays an important role in the
membrane potential of cells.

4.Calcium is the key component that mediates muscle

contraction; exocrine, endocrine, and neurocrine secretion;
cell growth; and the transport and secretion of fluids and
electrolytes.

5.Magnesium is essential for many biochemical

reactions; its pharmacologic properties have
only more recently been appreciated.
6. Phosphate stores and releases energy through
high-energy phosphate bonds and is integral to
the structure of proteins, lipids, and bone.
7.Chloride is the predominant anion in the ECF.
8.Glucose is a crucial fuel source, and insulin
facilitates glucose movement into cells in a
process that also requires potassium and
phosphate.

9.Diabetes

affects multiple organ systems, and the

perioperative effect of diabetes can be profound.
10. The most common causes of metabolic alkalosis are
antacid therapy, incidental administration of citrate with
blood products, sodium bicarbonate administration,
gastric drainage, and renal bicarbonate retention.
11. Metabolic acidosis is commonly caused by low cardiac
output and end-stage liver disease.
12. Transfusion of blood products improves tissue
oxygenation and decreases bleeding, but it also
increases the risk of transmission of infectious diseases,
transfusion reactions, immunosuppression, and
alloimmunization.
13. Anesthetics may blunt the normal physiologic
responses to hypovolemia and the stress response.
14. Shock is dysfunction of intracellular processes caused
by the lack of energy.

CONCENTRACIN DE ELECTROLITOS EN
SOLUCIONES TERAPETICAS
solucin

Amp
(ml)

miliequivalentes

Na

Mg Ca

Cl

ClNa 11.7% 20

40

40

ClNa 20%

20

68

68

ClK 14.9%

10

20

20

ClK 20%

10

26

26

SPE

Fco 90

2
0

80

GlCa 10%

10

So4Mg

10

4.5
10

HCO3

gluconat
o

4.5

CONCENTRACIONES DE ELECTROLI
Ion
Na
K
Ca
Mg

Plasma
140
4.5
5.0

intersticio intracelular
143.0
10.0
4.0
135.0
3.0
2.0

10.0
25.0

152.0
113.0

180.0
5.0

27.0
2.0

10.0
100.0

6.0

1.0
7.0

5.0
10.0

Proteinas

18.0

2.0

50.0

Aniones

152.0

152.0

180.0

Cationes
Cl
HCO3
HPO4
SO4
Ac. Organicos

2.5
152.0
101.0
24.0
2.0
1.0

Composicin de soluciones
utilizadas en terapia de
Na
K
Cl
HCO Mg Ca
Otros
[meq/lt]
fluidos
3
Suero Glucosado
al 5% frascos de 1
lt

Glucosa 50
gr por litro

Suero fisiolgico 0.9

0/0 frascos de 1lt

154

154

Bicarbonato de
sodio 3% y 8.4 0/0
amp de 20 ml

360

360

Lactato de sodio

167

167

Solucin de Ringer

147

156

Lactato de Ringer
1 lt

130

109

Haemacel 3.5% 500

ml

140

154

Dextran 4% 500 ml

140

154

4.6
28

3
9.5

Gelatina
Dextran 40

Fluidos corporales volumen

y concentracin de
electrolitos
mEq/l
Volumen
(ml/da)

Na

Cl

HCO3

SALIVA

1000 -1500

33

20

34

JUGO GSTRICO

2000 - 2500

60

10

85

BILIS

600 -1200

150

100

45

JUGO PANCRETICO

700 -1000

140

75

90

FLUJO DUODENAL

300 - 800

115

95

90

FLUJO ILEAL

1200 - 3000

120

11

116

29

FLUJO CECAL

200 - 500

80

21

48

22

LQUIDO CORPORAL

CONCEPTOS