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FLUID THERAPY

Total Body Water


• Water comprises a high percentage of body fluid,
with exact percentage dependent on:
– Sex
– Age
– Weight
• 50-70% of the average human is body fluids
– 45% extracellular fluid
– 55% intracellular
Total Body Water (cont.)
Total Body Water (cont.)
• The body maintains equilibrium between extracellular
& intracellular space: maintaining osmolality via
allowing water permeation between cell membranes.
(Fluid movement between intravascular & interstitial:
across capillary wall-filtration or diffusion)

• Osmolality:
particle content per liter of
water (mOsm/L)
• Normal osmolality in the
plasma: 285-290 mOsm/L
Definitions
• Intracellular: fluid within the cell
• Extracellular: fluid outside the cell but in the
interstitial space and intravascular
• Interstitial: fluid between the cells – in the
spaces between tissues
• Intravascular: within the vessels
Transport of Fluid
• Diffusion: the movement of molecules through a
semipermeable membrane from a high concentration to a
low concentration
• Osmosis: the one way passage of water through a
semipermeable membrane from a low concentration of
particles to a high concentration of particles
• Filtration: fluid going through a filter under pressure or
passage through a material that prevents passage of certain
molecules
• Active transport: Electrolytes move from a low
concentration to a high concentration by moving against
the concentration gradient. ATP provides energy needed to
do this.
Fluid Imbalance
Fluid imbalance can arise due to:
• Hypovolemia  dehydration:
Prescipitating factors: fasting, vomiting,
nausea, diarrhea, acute blood loss
• Hypervolemia: fluid overload:
Isotonic, colloid, plasma/blood >>
• Water intoxication: hypotonic >>
IV Fluid Therapy
Indications:
• Diarrhea:
– Severe dehydration
– Diarrhea is accompanied by severe uncontrolled vomiting
– Inability to comply with oral fluids
• Other:
– Hemorrhage
– Shock
– Electrolyte disturbance
– Supplying fluids and food for patients who are unable to
maintain oral intake
– Later on the fluid therapy is adjusted according loss in
stool and sweat
Uses of IV Therapy
• Maintain fluid and/or electrolyte balance, optimal
perfusion
• Administer medication continuously or intermittently
• Administer bolus medication
• Administer fluid to maintain venous access in case of an
emergency
• Administer blood or blood products
• Administer IV anesthetics
• Maintain patient’s nutritional status
• Administer diagnostic reagents
• Monitor haemodynamic functions
• Correct acidosis or alkalosis
Evaluation of Intravascular Volume
• Physical Examination
IV Therapy
• Intravenous fluid therapy may consist of
infusions of crystalloids, colloids, or a
combination of both
IV Therapy
• Types of IV fluids: • Distribution of IV Fluid
– Crystalloids: RA, RL, NaCl
0,9%
– Colloids: plasma,
albumin, dextran,
gelatin, strach
– Blood and blood
products
IV Therapy (cont.)
• Crystalloids
– Crystalloids are water with electrolytes that form a
solution that can pass through semipermeable
membranes
– Lost rapidly from the intravascular space into the
interstitial space. Remain in the extracellular
compartment for about 45 minutes
– Larger volume than colloids are required
– Water from crystalloids diffuses through the ICF
IV Therapy (cont.)
• Crystalloids
– Hypertonic (>300mOsm/L)
Draws fluid into the
intravascular compartment
from the cells & the interstitial
compartments
– Hypotonic (<280mOsm/L)
Shifts fluid out of the
intravascular compatment,
hydrating the cells and the
interstitial compartments
– Isotonic (280-300 mOsm/L)
Isotonic solution stays in the
intravascular space  expands
the intravascular compartment
IV Therapy (cont.)
• Common crystalloid
IV Therapy (cont.)
• Colloids
– Contain solutes in the form of large proteins or
other similar sized molecules
– Cannot pass through the walls of capillaries and
into cells
– Remain in blood vesselslonger and increase
intravascular vol
– Attract water from the cells into the blood vessels
– Prolonged movement can cause the cells to lose
too much water & become dehydrated
IV Therapy (cont.)
• Common Colloids
IV Therapy (cont.)
• Blood and Blood Products
Maintenance Therapy
• Goals of maintenance fluids:
– Prevent dehydration
– Prevent electrolyte disorders
– Prevent ketoacidosis
– Prevent protein degradation

• Infant are more susceptible for water loss due to:


– Physiological inability of their renal tubules to
concentrate
– Higher metabolic rate
– Larger body surface area
– Poorly developed thirst mechanism
– Larger turnover water exchange
Fluid and Electrolyte Requirements

 Fluid and electrolyte requirements: 25 – 30 ml / Kg BB


/ d water
Sensible vs Insensible Water Loss
• Sensible water loss (SWL), easily measured
– Urine, stool, OG/NG output, CSF

• Insensible water loss (IWL), not readily measured


– Evaporation from the skin (67%) or from respiration
(33%)
– IWL is greater in lower gestational age (immature skin)
– Factors that increase: immature skin, fever, radiant
warmer, phototherapy, skin defect/breakdown
– Factors that decrease: mature skin, humidity, heat-
shields
Electrolyte Maintenance
• Sodium, potassium, and chloride are given to
maintenance fluids to replace losses from urine
and stool
• Sodium ( Na + x BB x 0,4) : 2-3 mEq/kg/24hr
Potassium ( K + x BB x 0,6 ): 1-2 mEq/kg/24hr

Glucose  maintenance fluids usually contain 5%


dextrose (D5)  provides 17 calories/100mL 
prevent ketone production & protein
degeneration
Electrolytes
Estimated Fluid & Blood Loss
Strong Ion Difference
• SID is the charge imbalance of the strong ions
& is the sum of the concentration of the
strong base cations, less the sum of the
concentrations of the strong acid anions.
Calculating Maintenace Fluid Rates
(Children)
Holliday-Segar Method:
4 ml/kg for 1st 10kg BW
2 ml/kg for 2nd 10kg BW
+ 1 ml/kg for remaining kgs of BW

ie. 24 kg child
(4 ml X 10kg)+ (2 ml X 10kg) + (1 ml X 4kg) = 64
ml/hr