Feb 06, 2012 fluid and electrolyte management has to be aggressive. Organizing fluid needs into maintenance, deficit, and replacement therapy can provide a systematic, understandable approach to determining fluid therapy. Fluids and electrolytes composition of body fluid compartments. This article discusses the various types of oral and intravenous fluids that can be used by farm animal practitioners to treat these. Clinical features cns symptoms sodium electrolyte replacement therapy. Care for patients with fluid and electrolytes imbalance. Which is the most appropriate replacement fluid for a patient with significant nasogastric ng fluid. As hemodialysis hd and peritoneal dialysis pd are forms of renal replacement therapy and not an actual kidney, they do not possess the same physiologic regulation of both fluid and electrolytes. When critical care is considered for a sick calf, it is important to recognise whether the animal is hypovolaemic, dehydrated or both, as this will determine the treatment that is undertaken. In more stable patients, it is clinically useful to begin fluid therapy by estimating normal maintenance requirements using the estimated caloric expenditure method. Fluid and electrolyte therapy university of texas medical. Water and electrolyte balance is crucial for body homeostasis and is one of the most protected physiological mechanisms in the body. Fluid and electrolyte replacement therapy in children i maintenance fluid and electrolyte therapy a sources of water an electrolyte loss i insensible losses are fixed not homeostatically. This article focuses on fluid therapy in select cases of electrolyte abnormalities and fluid balance states, monitoring fluid therapy, and when and how to discontinue fluids.
This book, basic concepts of fluid and electrolyte therapy, fills a long felt need for an up to date pocket guide to the subject. Oral rehydration therapy ort is a type of fluid replacement used to prevent and treat dehydration, especially that due to diarrhea. Normal maintenance fluid and electrolyte requirements are, in general, determined by the childs metabolic rate. Potassium should not be added to intravenous fluid bags as this is dangerous. Intravenous fluid therapy introduction intravenous fluid ivf therapy has been used in clinical medicine since the 1830s during the european cholera epidemic severs 2015. Fluids, electrolytes, acidbase disorders, and nutrition support roland n.
Fluid, electrolytes, and nutrition in trauma patients. Potassium replacement protocol intravenous recommended rate of infusion is 10 meqh. Second, are there electrolyte abnormalities, and, concomitantly, what is the pathophysiology of the patients condition. Explain the uses of iv therapy, the role of red and white blood cells, platelets, plasma, and the six major electrolytes in intracellular and. Replacement fluid therapy for reptiles should be based on the animals hydration status and condition and available products. Electrolyte concentrations in the ecf and the icf electrolyte extracellular fluid meql. In this huge therapeutic area successful intravenous fluid management depends on making a clear distinction between the concept of fluid and. Ppt fluid and electrolyte therapy powerpoint presentation.
Many factors, such as illness, injury, surgery, and treatments, can disrupt a patients fluid and electrolyte balance. Fluid and electrolyte replacement therapy in children i maintenance fluid and electrolyte therapy a sources of water an electrolyte loss i insensible losses are fixed not homeostatically controlled and account for 50% of normal water losses 1 skin. In very unstable patients with abnormal or unpredictable losses, zero balance can be achieved only by frequent replacement of precisely measured losses. The simplest approach is to replace dehydration losses with 0. All maintenance therapies should contain at least 5% dextrose. As hemodialysis hd and peritoneal dialysis pd are forms of renal replacement. A free powerpoint ppt presentation displayed as a flash slide show on id. Oral rehydration salts and, when necessary, intravenous fluids and electrolytes, if administered in a timely manner and in adequate volumes, will reduce fatalities to well under 1% of all patients. Provide intravenous iv fluid therapy only for patients whose needs cannot be met by oral or enteral routes, and stop as soon as possible. Fluid replacement factsheet hs04059b 1205 dehydration dehydration is a loss of fluids and electrolytes important blood salts like potassium and sodium. Maintenance therapy with iv fluids is required to supply normal necessity of water and electrolyte to patient who cannot take them orally.
Clinicians have traditionally approached fluid therapy by first considering whether a patient is hypovolemic, euvolemic or hypervolemic. The physical exam will help determine clinical evidence of dehydration as evidenced by sunken eyes, decreased. A physical exam and thorough history are essential before developing a fluid replacement plan. Purposes of fluid administration during the perianesthetic period. Fluid therapy for the emergent small animal patient. Adult electrolyte replacement protocols summary standing electrolyte replacement protocols are available for use in adult patients admitted to orlando regional healthcare hospitals. These may due to increased or decreased intake, losses, shifts, underlying clinical conditions and. Approximate electrolyte concentrations in the extracellular and intracellular fluids ecf and icf fluid, electrolyte, and acidbase disorders. The kidney is a complex and vital organ, regulating the electrolyte and fluid status of the human body.
Adult electrolyte replacement protocols summary standing electrolyte replacement protocols are available for use in adult patients admitted to orlando regional healthcare. In more severe cases of electrolyte shortage, the substance can. You, the prescribing physician, must decide how much fluid to administer. Monitoring is an essential component of fluid therapy, and patients receiving iv fluids should be reassessed several times a day to determine whether the fluid plan needs to be altered. Intravascular volume replacement is the most common reason for. Hypotonic water replacement dka gastric fluid loss. Hypertonic a hypertonic solution draws fluid into the intravascular compartment from the cells and the interstitial compartments. Differentiate between the types of fluids used for fluid replacement in different disease states commonly seen in the intensive care unit. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Rehydration is the cornerstone of treatment for cholera. Approximate electrolyte concentrations in the extracellular and intracellular fluids ecf and icf fluid, electrolyte, and acidbase disorders, vol 1. Fluid and electrolyte management in surgical patients. Oral rehydration salts and, when necessary, intravenous fluids and electrolytes, if administered in a timely manner and in.
Many indications exist for ivf therapy in the critically ill population. Fluid and electrolyte management billie bartel and elizabeth gau le a r n i n g objectives 1. Changes should be anticipated and treated promptly. Infusion solutions belong to the most commonly prescribed medications. Many endotoxemic equine patients require fluid therapy for treatment of the underlying disease process and correction of dehydration and electrolyte and acidbase abnormalities. Fluid and electrolyte therapy dr ashoka acharya consultant paediatrics warwick hospital dehydration abnormal fluid losses overcoming renal compensating mechanisms. Fluid therapy is commonly performed in calves in farm animal practice. Purpose of iv therapy provide fluid and electrolyte maintenance, restoration, and replacement administer medication and nutritional feedings administer blood and blood products administer chemotherapy to cancer patients administer patientcontrolled analgesics keep a vein open for quick access. Patients with severe acute malnutrition should receive oral rehydration with lowosmolarity.
These are instituted upon direct physician order entry into sunrise xa. A similar calculation is made for potassium deficit, but it is assumed that 40% of the total water deficit has been lost from the intracellular fluid space icf and that the mean concentration of. Fluid therapy in hospitalized patients electrolyte. Pdf basic concepts of fluid and electrolyte balance. The assessment and management of patients fluid and electrolyte needs is fundamental to good patient care. A similar calculation is made for potassium deficit, but it is assumed. Purposes of fluid administration during the perianesthetic. Continuous renal replacement therapy jai radhakrishnan, md, ms. May 15, 2009 fluid and electrolyte therapy requires as much care as the administration of any drug. Fluid and electrolyte therapy is an essential component of the care of hospitalized children, and a thorough understanding of the changing requirements of growing children is fundamental in appreciating the many important pharmacokinetic changes that occur from birth to adulthood. Algorithms for iv fluid therapy in adults weightbased potassium prescriptions should be rounded to the nearest common fluids available for example, a 67 kg person should have. Fluid and electrolyte imbalances fluid and electrolyte balance is essential for health. Fluid therapy is divided into maintenance, deficit, and replacement requirements. Fluids, electrolytes, acidbase disorders, and nutrition.
Fluid therapy is a mainstay of therapy of most endotoxemic patients suffering from the cardiovascular effects of systemic inflammation. Fluid and electrolyte therapy a chapter in core concepts of pediatrics, 2nd edition. Clinicians have traditionally approached fluid therapy by first considering whether a. Even a patient with a minor illness is at risk for fluid and electrolyte imbalance. Identify and understand basic fluid and electrolyte abnormalities in critically ill patients. Fluid and electrolyte disturbances are common in traumatic injury patients. Fluid and electrolyte therapy requires as much care as the administration of any drug.
Replacement therapy is required when there is excess loss of water and electrolytes caused by fever, severe vomiting and diarrhoea. Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Algorithms for iv fluid therapy in adults weightbased potassium prescriptions should be rounded to the nearest common fluids available for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24hour period. The electrolyte replacement protocols, calcium chloride level i areas only or calcium gluconate all levels of care, magnesium sulfate, potassium chloride, or potassium phosphate, may be ordered individually or in combination. Clinical features cns symptoms sodium nov 20, 2017 they rely on the movement of electrolytes through the fluid inside, outside, or between cells. Uses of iv therapy establish or maintain fluid andor electrolyte balance 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 intravenous anaesthetics. Electrolytes and fluid management in hemodialysis and. Oral rehydration therapy can also be given by a nasogastric tube. Intravenous fluid therapy in adults in hospital nice. The goal of maintenance therapy is the accurate replacement of ongoing water and electrolyte losses to maintain zero balance. Specialist units have specific protocols for electrolyte disturbances and fluid therapy and these take precedence over the. Pdf managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. Dec 08, 2018 maintenance therapy with iv fluids is required to supply normal necessity of water and electrolyte to patient who cannot take them orally. Fluids, electrolytes, acidbase disorders, and nutrition support.
Fluid and electrolyte replacement therapy in childre1. The patient should be weighed at least once daily and have at least 2 physical examinations per day to assess intravascular volume and hydration status. Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. W e drink water, or a watercontaining beverage, five to ten times a day. Replacement fluid therapy lrs, plasmalyte a, normosol, 0.