ElectrolyteReplacement.ppt

Electrolyte Replacement Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of Dundee PRINCIPLES OF FLUIDS AND ELECTROLYTES Fluid Compartments Example: 70-kg male Total Body Water: 42,000 mol (60% of BW) Intracellular: 28,000 mL (40% of BW) Extracellular: 14,000 mL (20% of BW) Plasma: 3500 mL (5% of BW) Interstitial: 10,500 mL (15% of BW) Water Balance70-kg male The minimum obligate water requirement to maintain homeostasis (assuming normal temperature and renal concentrating ability and minimal solute [urea, salt] excretion) is about 800 mL/d, which would yield 500 mL of urine. Normal Intake Oral liquids: 1500 mL Oral solids: 700 mL Metabolic (endogenous): 300 mL “Normal” Output:1400-2300 mL/d Urine: 800-1500 mL Stool: 250 mL Insensible loss: 600-900 mL (lungs and skin). (With fever, each degree above98.6 F adds 2.5 mL/kg/d to insensible loss; insensible losses are decreased if a patientis on a ventilator; free water gain may occur from humidified ventilation.) Baseline Fluid Requirement Afebrile 70-kg Adult: 35 mL/kg/24 h If not a 70-kg Adult: Calculate the water requirement according to Kg Method: For the first 10 kg of body weight: 100 mL/kg/d plus For the second 10 kg of body weight: 50 mL/kg/d plus For the weight above 20 kg: 20 mL/kg/d Electrolyte Requirements:70-kg adult Sodium (as NaCl): 80-120 mEq (mmol)/d (Pediatric patients, 3-4 mEq/kg/ 24 h [mmol/kg/24 h]) Chloride: 80-120 mEq (mmol)/d, as NaCl Potassium: 50-100 mEq/d (mmol/d) (Pediatric patients, 2-3 mEq/kg/24 h [mmol/kg/24 h]). Calcium: 1-3 gm/d, Magnesium: 20 mEq/d (mmol/d). Electrolyte Requirements Potassium: In the absence of hypokalemia and with normal renal function, most of this is excreted in the urine. Of the total amount of potassium, 98% is intracellular, and 2% is extracellular. Thus, assuming the serum potassium level is normal, about 4.5 mEq/L (mmol/L), the total extracellula