Basic Concepts of Fluid and Electrolyte Therapy

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Preface Despite the fact that fluid and electrolyte preparations are the most commonly prescribed medications in hospitals, a number of studies have shown that the knowledge and practice of fluid and electrolyte balance among young doctors is suboptimal, possibly due to inadequate teaching. This is responsible for errors in management, which continue to cause avoidable morbidity and even mortality. It is not the intention of the authors of this book to write a comprehensive textbook dealing with complex problems, but to provide a pocket book for students, nurses and young doctors to help them to understand and solve some of the most common practical problems they face in dayto-day hospital practice. The authors hope that it will also stimulate them to pursue the subject in greater detail with further reading and practical experience. In difficult cases, the young doctor should never hesitate to ask for advice from senior and experienced colleagues. Dileep N. Lobo Andrew J. P. Lewington Simon P. Allison 4
Foreword This book, ‘Basic Concepts of Fluid and Electrolyte Therapy’, fills a long felt need for an up to date pocket guide to the subject. Water and electrolyte balance is crucial for body homeostasis and is one of the most protected physiological mechanisms in the body. While we can survive for months without food, without water intake we die very quickly. Similarly the body has very strong mechanisms to control salt and water balance, an understanding of which has major implications in clinical practice. Despite salt and water balance being so fundamental for homeostatic control, knowledge and practice of fluid and electrolyte therapy has been shown to be appallingly poor among many health care professionals. The results of such knowledge surveys have been reported by the authors and were surely the reason why they felt the urge to write this book. Dileep Lobo, Andrew Lewington and Simon Allison are all well renowned experts in this field covering different aspects of the topic: surgery, renal medicine and clinical nutrition. This allows for a broad approach to the concepts of fluid and electrolyte management and gives the book sufficient depth to fulfil the basic needs of all medical specialties. The book covers the basics in physiology and pathophysiology, how to assess fluid and electrolyte status, a clear overview of fluids used in clinical practice and how to prescribe them, and then moves on to describe and discuss some of the most common clinical problems. The book is rich in tables and figures that help the reader grasp the fundamentals, both physiological and pathophysiological. It contains examples of how to address clinical situations and to monitor treatment, often with the help of simple cartoons and figures. The authors 5
Page 1 and 2: Dileep N. Lobo Andrew J. P. Lewingt
Page 3: Basic Concepts of Fluid and Electro
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 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
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(3) The answer to this question is
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6. Methods of Fluid Administration
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Central Modern single or multi lume
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7. Acid-Base Balance Introduction M
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vide a simple description of the mo
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change in Pco 2 = respiratory proce
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Table 15: Causes of metabolic acido
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Renal HCO 3 - loss results from re
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Mixed acid-base disorders These are
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Urine output should be interpreted
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assess clinical response to fluid i
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Oliguria following surgery 48 h and
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Definition AKI is a result of a rap
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AKI is most commonly secondary to a
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History Examination Investigations
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Management Prevention Any patient a
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if no clinical response and no pulm
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acidosis pH 7.2-7.4 - there is ver
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Referral to nephrologist NOT all p
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Follow up Acute kidney injury is a
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DKA and HONK represent the two extr
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Fluids and insulin In the absence
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Surgery in the patient with diabete
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10 mmol/l/day. In the differential
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portionately more water is lost tha
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Hypokalaemia: a fall in serum conce
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Four common aspects of Ca 2+ disord
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Treatment depends on severity and c
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112
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Hypophosphataemia
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116
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Prolonged periods of preoperative f
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position to postoperative parotitis
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13. *Chowdhury AH, Lobo DN. Fluids
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42. Hussein H, Lewington A, Kanagas
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67. *Michell AR. Diuresis and diarr
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94. *Stewart PA. Modern quantitativ
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colloids 7, 26, 41, 42, 43 44, 45,
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intravascular compartment 20, 41, 4
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Stewart approach 63, 71 sympathetic
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Dileep N. Lobo Andrew J. P. Lewingt
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