Fluid & Electrolytes in Surgery
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Transcript of Fluid & Electrolytes in Surgery
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FLUID AND FLUID AND ELECTROLYTESELECTROLYTES
IN SURGICAL AND TRAUMA IN SURGICAL AND TRAUMA PATIENTSPATIENTS
By By Dr. Abul Fazal Ali Khan Dr. Abul Fazal Ali Khan Professor of Surgery Professor of Surgery
Allama Iqbal Medical College LahoreAllama Iqbal Medical College Lahore
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SURGICAL AND TRAUMA PATIENTSSURGICAL AND TRAUMA PATIENTS
Unique ChallengesUnique Challenges Critically illCritically ill
Great careGreat care
Body’s Response to StressBody’s Response to Stress
Impact on fluid and electrolytes Impact on fluid and electrolytes homeostasishomeostasis
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ECF DISTURBANCEECF DISTURBANCE
Fluid RestrictionFluid Restriction Diagnostic proceduresDiagnostic procedures Bowel preparationBowel preparation Loss from GITLoss from GIT FeverFever
Acute Loss of ECFAcute Loss of ECF Recognition & TreatmentRecognition & Treatment Prevent Later ComplicationsPrevent Later Complications
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NEUROENDOCRINE RESPONSENEUROENDOCRINE RESPONSE Major SurgeryMajor Surgery TraumaTrauma Different StimuliDifferent Stimuli
HemorrhageHemorrhage HypovolemiaHypovolemia PainPain AnesthesiaAnesthesia HypoxiaHypoxia
EuvolemiaEuvolemia PerfusionPerfusion
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HYPOVOLEMIAHYPOVOLEMIA
Blood LossBlood Loss SequestrationSequestration Various HormonesVarious Hormones
ACTHACTH ADHADH ReninRenin AldosteroneAldosterone CatecholaminesCatecholamines
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HORMONAL RESPONSEHORMONAL RESPONSE
RAA SystemRAA System Increased sympathetic stimulationIncreased sympathetic stimulation Decreased perfusionDecreased perfusion Decreased sodium chlorideDecreased sodium chloride
VasopressinVasopressin HypovolemiaHypovolemia PainPain Head injuryHead injury Water retentionWater retention
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SEQUESTRATIONSEQUESTRATION
Normal Acute injury IV sol. Resolution
ICF
IF
PL
SF
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FLUID LOSSFLUID LOSS
Insensible LossInsensible Loss SweatingSweating StoolsStools External LossesExternal Losses Internal ShiftsInternal Shifts Loss of ElectrolytesLoss of Electrolytes
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DEFICITDEFICIT
FormulaFormula 4 : 2 : 14 : 2 : 1
50 kg/7 Hours50 kg/7 Hours 10 x 4 x 7 = 280ml (first 10 kg)10 x 4 x 7 = 280ml (first 10 kg) 10 x 2 x 7 = 140ml (next 10 kg)10 x 2 x 7 = 140ml (next 10 kg) 30 x 1 x 7 = 210ml (rest 30 kg)30 x 1 x 7 = 210ml (rest 30 kg) Total : 630mlTotal : 630ml
Insensible LossInsensible Loss 0.5ml/kg/hour0.5ml/kg/hour 10% increase10% increase
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CONSEQUENCESCONSEQUENCES
Early PostoperativeEarly Postoperative
Water retentionWater retention HyponatremiaHyponatremia
Late PostoperativeLate Postoperative
HypokalemiaHypokalemia
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MANAGEMENTMANAGEMENT
ECF ReplacementECF Replacement
Provision of ElectrolytesProvision of Electrolytes
Early periodEarly period
Late periodLate period
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FLUID REPLACEMENTFLUID REPLACEMENT
5% D extrose W ater
Intracellular fluid666 m l
Intravascular83 m l
Extravascular250 m l
Extracellular fluid333 m l.
1000 m l
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HYPONATREMIAHYPONATREMIA
Water Used to Replace Salt LossesWater Used to Replace Salt Losses GI lossesGI losses ElderlyElderly
Salt-wasting kidneysSalt-wasting kidneys
Water Administration Exceeds Water Water Administration Exceeds Water LossesLosses ADH SecretionADH Secretion
Post-op periodPost-op period Head injuryHead injury
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FLUID REPLACEMENTFLUID REPLACEMENT
Balanced Sa lt So lu tion
Intrace llular fluid0 m l
Extravascular750 m l.
Intravascular250 m l.
Extracellular fluid1000 m l.
1000 m l
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RINGOLACT-DRINGOLACT-D
Initial TherapyInitial Therapy Composition Quite Similar to Extracellular Composition Quite Similar to Extracellular
FluidFluid Dextrose is Added as an Energy SourceDextrose is Added as an Energy Source Prevents GluconeogenesisPrevents Gluconeogenesis
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COMPARISONCOMPARISON
Electrolytes (mEq/L)Electrolytes (mEq/L) ECFECF Ringolact-DRingolact-D
NaNa 142142 130130 KK 44 44 ClCl 103103 108.7108.7 CaCa 55 2.72.7 HCOHCO33 2727 2828 Dex.Dex. VarVar 50(g/L)50(g/L)
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HYPOKALEMIAHYPOKALEMIA
Most Common AbnormalityMost Common Abnormality Renal ExcretionRenal Excretion IV SolutionsIV Solutions Inadequate IntakeInadequate Intake GI LossesGI Losses
VomitingVomiting Nasogastric tubeNasogastric tube DrainageDrainage
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HYPOKALEMIAHYPOKALEMIA
SecretionSecretion AmountAmount
(mEq/L)(mEq/L)
GastricGastric 10 10
DuodenalDuodenal 15 15
BiliaryBiliary 5 5
PancreaticPancreatic 5 5
JejunalJejunal 6 6
IlealIleal 8 8
ColonicColonic 90 90
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HYPOKALEMIAHYPOKALEMIA
Clinical ManifestationsClinical Manifestations Depend on SeverityDepend on Severity
FatigueFatigue MyalgiasMyalgias Muscular WeaknessMuscular Weakness ECG ChangesECG Changes Respiratory Muscle FatigueRespiratory Muscle Fatigue ArrhythmiasArrhythmias Decreased GI MotilityDecreased GI Motility Paralytic IleusParalytic Ileus
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HYPOKALEMIAHYPOKALEMIA
Intracellular CationIntracellular Cation Decrease of 1 mEq/LDecrease of 1 mEq/L
Deficit of 200-400 mEqDeficit of 200-400 mEq Decrease of 0.27 mEq/LDecrease of 0.27 mEq/L
Deficit of 100 mEqDeficit of 100 mEq Daily RequirementsDaily Requirements
40 mEq for baseline renal loss40 mEq for baseline renal loss 20 mEq for GI losses20 mEq for GI losses Total 60 mEq/dayTotal 60 mEq/day
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HYPOKALEMIAHYPOKALEMIA
IV AdministrationIV Administration Maximum ConcentrationMaximum Concentration
40 mEq/L (peripheral)40 mEq/L (peripheral) Maximum RateMaximum Rate
10 mEq/hour10 mEq/hour Cardiac MonitoringCardiac Monitoring
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PLABOLYTE-MPLABOLYTE-M
Maintenance SolutionMaintenance Solution
Replaces Lost Potassium in Late Post-Replaces Lost Potassium in Late Post-operative Periodoperative Period
Potassium : Potassium : 20 mEq/L20 mEq/L
Low Sodium ContentLow Sodium Content
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PLABOLYTE-MPLABOLYTE-M
Elec.(mEq/L)Elec.(mEq/L) NaNa :: 6060 KK :: 2020 ClCl :: 6060 CaCa :: 33 HCOHCO33 :: 2323 Dextrose:Dextrose: 50(g/L)50(g/L)
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CONCLUSIONCONCLUSION
Ringolact-DRingolact-D Immediate Post-operative PeriodImmediate Post-operative Period
Plabolyte-MPlabolyte-M Late Post-Operative PeriodLate Post-Operative Period
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