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
Distribution of fluid in the body:
1/3 extracellular fluid
Interstitial fluid
Plasma or intravascular fluid
Transcellular fluid
2/3 intracellular
Fluid within a cell
RBC
Other cells
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 in itravascular fluid
Interstitial: fluid between the cells in the
interspaces of a tissue
Intravascular: within the vessel/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 patients 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
Water loss (24 hr)
Urine/24 hours : 1.500 ml
Insensible water loss 1,3 x 700 ml : 900 ml
Water & feces : 100 ml
------------
Total : 2.500 ml

Fluid and electrolyte requirements: 25 30 ml / Kg BB

/ d water
 Insensible Water Loss

Adult Children Infant

42 ml / 100 cal 300-600 ml / d 75-300 ml / d
Water loss
Skin = 800 ml
Lung = 400 ml
10-20 ml / 100 cal - No significance
Sweat (minimum activity)
50 ml / 100 cal
(heavy activity)
84 ml / 100 cal = 90 ml / 100 cal = 100 ml / 100 cal =
Urine 1500 ml 500-800 ml 200-500 ml
4 ml / 100 cal 4 ml / 100 cal 4 ml / 100 cal
Feces
 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