Fluid Therapy

Dr. Denson Smiley U. Dongi-is, MD

Body Fluid Compartments
Total Body Water (TBW) = 50-70% of total
body weight
Average is greater for males
Decreases with age. Highest in newborns,
75-80%. By first year of life TBW is
approximately 65%.
TBW = Extracellular Fluid (ECF) (1/3) +
Intracellular Fluid (ICF) (2/3)
ECF = Intravascular (1/3) + Interstitial (2/3)
Body Fluid Compartments
Total body water volume = 40L, 60% body weight

Extracellular fluid volume

= 15 L, 20% body weight

Intracellular fluid
Interstitial fluid
volume Plasma volume
volume
=25L, 40% body =3L, 20% of ECF
=12L, 80% of ECF
weight
Electrolyte Physiology
Primary Extracellular Fluid cation is Na+. Very
small contribution of K+, Ca+, and Mg+.
Primary Extracellular Fluid anion is Cl-. Small
contribution HCO3, SO42-, and PO43-,
organic acids and protein
Primary ICF cation is K+, smaller contribution
from Mg+ and Na+
Number of Intravascular anions are not
routinely detected
Electrolyte Physiology
ICF (mEq/L) ECF (mEq/L)
Cations K+ (150-154) NA+(142)
Na+ (6-10) Ca+2(5)
Mg2+ (40) K+(-5)
Mg+2(3)
Anions Organic PO4-3(100-105) CI- (103-105)
Protein (40-60) HCO3- (24-27)
SO4-2 (17) Protein (15)
HCO3- (10-13) PO4-3(3-5)
Organic Acids(4) SO4-2 (4)
Organic Acids (2-5)
Types of IVF
Crystalloid
Balanced salt/electrolyte solution
Forms a true solution and is capable of
passing through semipermeable
membranes.
May be isotonic, hypertonic, or hypotonic.
Examples:
1. Normal Saline (0.9% NaCl)
2. Lactated Ringers Solution
3. Hypertonic Saline (3,5 & 7.5%)
IVF Composition
IVF Na K+ Cl+ HCO3- Mg++ Ca++
(mEq/L) (mEq/L) (mEq/L) (mEq/L) (mEq/L) (mEq/L)

pLR 130 4 109 28 - 3

(lactate)

pNSS 154 - 154 - - -

D5 0.3
51 - 51 - - -
NaCl
D5IMB 25 20 22 - 3 -

D5NR 140 4 98 27 - -
(lactate)

D5NM 40 13 40 16 3 -
(lactate)
IVF Prescription
Questions to ask before prescribing fluids:
1. Is my patient euvolemic, hypovolemic or
hypervolemic?
2. Does my patient need IV fluid? Why?
3. How much?
4. What type(s) of fluid does my patient
need?
IVF Prescription
Ismy patient euvolemic, hypovolemic, or
hypervolemic?

Euvolemic:
Veins are well filled, extremities are warm,
blood pressure and heart rate are normal
(depending on other pathology).
IVF Prescription
Ismy patient euvolemic, hypovolemic or
hypervolemic?

Hypovolemic:
The patient may have cold hands and feet,
absent veins, hypotension, tachycardia,
oliguria and confusion.
History of fluid loss or low intake.
IVF Prescription
Ismy patient euvolemic, hypovolemic or
hypervolemic?

Hypervolemic:
The patient is edematous, may have
inspiratory crackles.
History of poor urine output or fluid overload.
IV Prescription
Does my patient need IV Fluid?

NO:
Drinking adequately
Receiving adequate fluid via NG feed or TPN
Receiving large volumes with drugs or drug infusions (or a
combination of these)

Allow patients to drink if at all possible

Hypervolaemic: may need fluid restriction or gentle diuresis.

YES:
Not drinking.
Has lost or is losing fluid
 IVF Prescription
Why does my patient need IV Fluids?

Maintenance fluid only

Patient does not have excess losses above insensible loss.
If no other intake he needs approximately 30ml/kg/24hrs.
Patients having to fast for over 8-12 hours should be started on IV
maintenance fluid.

Replacement of losses wither previous or current

If losses are predicted it is best to replace these later rather than
give extra fluid in anticipation of losses which may not occur.
This fluid is in addition to maintenance fluid.

Resuscitation
The patient is hypovolemic as a result of:
1. Dehydration
2. Blood loss or sepsis
3. Requires urgent correction of intravascular depletion to correct deficit
IVF Prescription
How much fluid does my patient need?

a. Obtain weight (estimate if required)

b. Review recent intake and output, other
electrolytes and hemoglobin
c. Recent events like fasting, intake, losses, sepsis,
operations, fluid overload. Check fluid balance
charts.
d. Calculate how much loss has to be replaced
and work out which type of fluid has been lost
like GI secretions, blood, inflammatory losses.
IV Prescription