postoperative fluid management

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perioperative fluid therapy postoperative fluid management prepared by dilja mary intern total body water approx. 60% body weight varies with age, gender and body habitus 50% bw in females 80% bw in infants body water compartments intracellular volume : 2/3 of tbw extracellular volume : 1/3 of tbw - intravascular : plasma volume (1/4) - extravascular: interstitial fluid and others(3/4) intravenous fluids therapy intravenous fluid therapy may consist of infusions of crystalloids, colloids, or a combination of both. indications volume resuscitation vehicle for i/v drugs types crystalloids colloids crystalloids clear fluids made up of water and electrolyte solutions; will cross a semi-permeable membrane grouped as isotonic, hypertonic, and hypotonic eg: normal saline 0.9%,3 % dextrose solutions 5 %,10%,20%,25% dns ringer’s lactate isolyte p 6 crystalloids are fluids that contain water and electrolytes. they are grouped as isotonic, hypertonic, and hypotonic salt solutions. crystalloid solutions are used to provide maintenance water …

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e na+ 77mmol/l, cl- 77mmol/l, osmo 154mosm/l indications : fluid therapy for paediatric pt maintenance fluid therapy complications : leads to hyponatraemia if plasma sodium is normal may cause rapid reduction in serum sodium if used in excess or infused too rapidly. this may lead to cerebral oedema and rarely, central pontine demyelinosis. 3.0 % saline = hypertonic saline 3% contain 513 mmol/l of na+ and cl- each, osmol of 1026 mosm/l; ph 5.0 indications : treatment of severe symptomatic hyponatremia (coma, seizure) to resuscitate hypovolemic shock 10 hypertonic salt solutions hypertonic salt solutions are less commonly used, and their sodium concentrations range from 250 to 1200 meq/l. the greater the sodium concentration, the less the total volume is required for satisfactory resuscitation. this difference reflects the movement owing to osmotic forces of water from the intracellular space into the extracellular space. the reduced volume of water injected may reduce …

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s risk of causing phlebitis, necrosis, hemolysis. complications : precaution in pt. with chf severe renal insufficiency, edema with sod. retention. dextrose 5% dextrose (often written d5w) 50g/l of glucose, 252mosm/l, ph 4.5 regarded as ‘electrolyte free’ – contains no sodium, potassium, chloride or calcium indication : primarily used to maintain water balance in patients who are not able to take anything by mouth; commonly used post-operatively in conjunction with salt retaining fluids ie saline hypernatremia treatment – think of it as ‘sugar and water’ 12 when infused is rapidly redistributed into the intracellular space; less than 10% stays in the intravascular space therefore it is of limited use in fluid resuscitation. side effects: iatrogenic hyponatraemia in surgical patient ringer lactate most physiological solution electrolyte composition similar to ecf one litre of lactated ringer's solution contains: sodium ion= 130 mmol/l. chloride ion = 109 mmol/l. lactate = 28 mmol/l. potassium …

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y can cause significant coagulopathy in large volumes. natural : albumin artificial : gelatin and dextran , hes albumin principal natural colloid comprising of 50-60% of all plasma proteins. synthesized only in liver and has a half life of app. 20 days. 5% soln is iso oncotic and leads to 80% initial vol expansion 25% soln leads to 200-400% increase in vol. used for emergency treatment of shock especially due to loss of plasma, acute management of burns fluid resuscitation in icu hypoalbumineamia. side effects : pruritis, anaphylactoid reactions and coagulation abnormalities as compared to synthetic colloids. disadvantages cost effectiveness volume overload dextran highly branched polysaccharide molecules produced by synthesis using the bacterial enzyme dextran sucrase from the bacterium leuconostoc mesenteroids. most widely used are 6%(dextran 70) and 10%(dextran 40) soln. excreted via kidney primarily. both lead to a higher vol expansion as compared to hes and 5% albumin. used …

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ect exceeding the infused vol .(about 145%) duration of vol expansion is usually 8-12 h. advantage cost effective: cheaper and comparable vol of expansion to albumin. disadvantage: - coagulation abnormality. - accumulation - anaphylactoid reactions - renal impairment - increase in amylase level colloid or crystalloid resuscitation recommendations: colloid should not be used as the sole fluid replacement in resuscitation ,volumes infused should be limited because of side effects and lack of evidence for their continued use in the acutely ill. in severely ill patients – principally use crystalloid and blood products; colloid may be used in limited volume to reduce volume of fluids required or until blood products are available. in elective surgical patients replace fluid loss with ‘physiological ringer’s solutions. blood products and colloid may be needed to replace intravascular volume acutely. compensatory intravascular volume expansion most gen and regional anaesthetics cause arteriolar and venous dilatation, expanding the …

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perioperative fluid therapy postoperative fluid management prepared by dilja mary intern total body water approx. 60% body weight varies with age, gender and body habitus 50% bw in females 80% bw in infants body water compartments intracellular volume : 2/3 of tbw extracellular volume : 1/3 of tbw - intravascular : plasma volume (1/4) - extravascular: interstitial fluid and others(3/4) intravenous fluids therapy intravenous fluid therapy may consist of infusions of crystalloids, colloids, or a combination of both. indications volume resuscitation vehicle for i/v drugs types crystalloids colloids crystalloids clear fluids made up of water and electrolyte solutions; will cross a semi-permeable membrane grouped as isotonic, hypertonic, and hypotonic eg: normal saline 0.9%,3 % dextrose solutio...

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