Basic Concepts of Fluid and Electrolyte Therapy

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Osmolality In the presence of AKI, a urine osmolality of >500 mOsm/kg is indicative of a pre-renal cause (e.g. fluid deficit), whereas one
the plasma sodium has fallen, the balance of water is positive and hyponatraemia is dilutional. The next prescription should include less water and the same sodium intake as before. An alternative approach to sodium balance is to measure intake and the sodium content of all fluids lost. This however, is difficult to do accurately as well as being more demanding in staff time and resources. A falsely low serum sodium may be caused by hypertriglyceridaemia, since triglycerides expand the plasma volume but contain no sodium. Similarly hyponatraemia occurs in the presence of hyperglycaemia as in decompensated diabetes, since glucose also acts as an osmotic agent holding water in the ECF. This effect disappears as soon insulin treatment causes cellular uptake of glucose and lowering of its concentration in the blood. Potassium The normal serum potassium concentration lies between 3.5 and 5.3 mmol/l. Concentrations rising above 5.5 mmol/l progressively increase the risk of death from cardiac arrest and require urgent treatment which may include extra fluids, intravenous glucose and insulin, bicarbonate, calcium gluconate (to stabilise the myocardium), intrarectal calcium resonium and even renal replacement therapy. Conversely, concentrations below 3.0 mmol/l increase the risk of arrhythmias and indicate the need for potassium supplementation by the oral or intravenous route. 37
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 18 and 19: Conversely, if the intake of Na + i
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 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
Page 80 and 81: 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
Page 120 and 121:
position to postoperative parotitis
Page 122 and 123:
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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