Basic Concepts of Fluid and Electrolyte Therapy

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Conversely, if the intake of Na + is excessive, the renin-aldosterone system switches off, allowing more Na + to be excreted, until normal balance is restored. The mechanism for salt conservation is extremely efficient and the kidney can reduce the concentration of Na + in the urine to
Pathophysiology Diseases such as gastroenteritis, diabetic ketoacidosis or Addison’s disease cause their own specific changes in fluid and electrolyte balance, but there are non-specific changes which occur in response to any form of injury or inflammation, which have important implications for management, particularly of surgical patients. Response to injury In the 1930’s, Cuthbertson described the metabolic changes, which occur in response to injury (including surgery and sepsis), as an increase in metabolic rate and protein breakdown to meet the requirements for healing. These changes were later shown to be due to neuroendocrine and cytokine changes and to occur in three phases. The ebb or shock phase is brief and is modified by resuscitation. This gives way to the flow or catabolic phase, the length and intensity of which depends on the severity of injury and its complications. As inflammation subsides, the convalescent anabolic phase of rehabilitation begins. In parallel with these metabolic changes there are changes in water and electrolyte physiology. During the flow phase, there is an increase in ADH and aldosterone secretion leading to retention of salt and water with loss of potassium. These changes are exacerbated by any reduction in blood or ECF volume. The normal, if somewhat sluggish, ability to excrete an excess salt and water load is further diminished , leading to ECF expansion and oedema. The response to injury also implies that oliguria is a normal response to surgery, and does not necessarily indicate the need to increase the administration of salt and water or plasma expanders unless there are also indications of intravascular volume deficit, e.g. from postoperative bleeding. Salt and water retention after injury can be seen as nature’s way of trying to protect the ECF and circulating 19
Page 1 and 2: Dileep N. Lobo Andrew J. P. Lewingt
Page 3 and 4: Basic Concepts of Fluid and Electro
Page 5 and 6: Foreword This book, ‘Basic Concep
Page 7: Table of Contents 1. Normal Physiol
Page 10 and 11: ever, contains large anions such as
Page 12 and 13: Oral intake 1.5-2 L Saliva 1.5 L Ga
Page 14 and 15: Table 2: Normal maintenance require
Page 16 and 17: Kidney: this is the main organ for
Page 20 and 21: volume at all costs. It also explai
Page 22 and 23: Conclusion Appropriate fluid therap
Page 24 and 25: Intravascular fluid volume - the to
Page 26 and 27: Colloid - a fluid consisting of mic
Page 28 and 29: Base excess - Base excess is define
Page 30 and 31: Parameter Urine output Significance
Page 32 and 33: Figure 5: Example of a vital signs
Page 34 and 35: Fluid balance charts These provide
Page 36 and 37: Osmolality In the presence of AKI,
Page 38 and 39: Chloride Despite the fact that seru
Page 41 and 42: 4. Properties of Intravenous Crysta
Page 43 and 44: 6-12 h. The colloid should be metab
Page 45 and 46: Table 8: Advantages and disadvantag
Page 47: Plasma- Sterofundin 0.18% Plasma-Ly
Page 50 and 51: 50 Patients receiving artificial nu
Page 52 and 53: Once resuscitation has been achieve
Page 54 and 55: (3) The answer to this question is
Page 57 and 58: 6. Methods of Fluid Administration
Page 59 and 60: Central Modern single or multi lume
Page 61 and 62: 7. Acid-Base Balance Introduction M
Page 63 and 64: vide a simple description of the mo
Page 65 and 66: change in Pco 2 = respiratory proce
Page 67 and 68: Table 15: Causes of metabolic acido
Page 69 and 70:
Renal HCO 3 - loss results from re
Page 71:
Mixed acid-base disorders These are
Page 74 and 75:
Urine output should be interpreted
Page 76 and 77:
assess clinical response to fluid i
Page 78 and 79:
Oliguria following surgery 48 h and
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Definition AKI is a result of a rap
Page 82 and 83:
AKI is most commonly secondary to a
Page 84 and 85:
History Examination Investigations
Page 86 and 87:
Management Prevention Any patient a
Page 88 and 89:
if no clinical response and no pulm
Page 90 and 91:
acidosis pH 7.2-7.4 - there is ver
Page 92 and 93:
Referral to nephrologist NOT all p
Page 94 and 95:
Follow up Acute kidney injury is a
Page 96 and 97:
DKA and HONK represent the two extr
Page 98 and 99:
Fluids and insulin In the absence
Page 100 and 101:
Surgery in the patient with diabete
Page 102 and 103:
10 mmol/l/day. In the differential
Page 104 and 105:
portionately more water is lost tha
Page 106 and 107:
Hypokalaemia: a fall in serum conce
Page 108 and 109:
Four common aspects of Ca 2+ disord
Page 110 and 111:
Treatment depends on severity and c
Page 112 and 113:
112
Page 114 and 115:
Hypophosphataemia
Page 116 and 117:
116
Page 118 and 119:
Prolonged periods of preoperative f
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position to postoperative parotitis
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13. *Chowdhury AH, Lobo DN. Fluids
Page 124 and 125:
42. Hussein H, Lewington A, Kanagas
Page 126 and 127:
67. *Michell AR. Diuresis and diarr
Page 128 and 129:
94. *Stewart PA. Modern quantitativ
Page 130 and 131:
colloids 7, 26, 41, 42, 43 44, 45,
Page 132 and 133:
intravascular compartment 20, 41, 4
Page 134 and 135:
Stewart approach 63, 71 sympathetic
Page 136:
Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electrolyte Therapy

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