Basic Concepts of Fluid and Electrolyte Therapy

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Conditions commonly associated with acid-base disorders include: vomiting/diarrhoea shock cardiogenic septic hypovolaemic acute kidney injury respiratory failure altered neurological status coma seizures decompensated diabetes hypo- or hyperkalaemia potassium metabolism is intimately linked with acid-base balance prolonged and excessive infusions of saline If an acid-base disturbance is suspected from clinical features the following investigations should be performed initially: Urea, creatinine and electrolytes Bicarbonate Chloride Arterial blood gases (including lactate) Step-by-step pathway to identify underlying cause pH to determine whether acidaemia or alkalaemia change in bicarbonate and base excess = metabolic process 64
change in Pco 2 = respiratory process determine whether simple disorder i.e. either metabolic or respiratory process alone mixed disorder i.e. a combination of a metabolic and respiratory process occurring together. There will be evidence of compensatory changes in either bicarbonate or Pco 2 calculate the anion gap determined primarily by negative charge on serum proteins, particularly albumin serum anion gap = unmeasured anions – unmeasured cations anion gap = [Na + ] – ([HCO – 3 ] + [Cl – ]) normal anion gap = 5-11 mmol/l in hypoalbuminaemia the normal anion gap is adjusted downward by 2.5 mmol/l for every 10 g/l reduction in serum albumin concentration an increase in anion gap indicates a tendency towards acidosis and a decrease a tendency towards alkalosis. measure blood sugar, serum lactate and/or -hydroxybutyrate concentrations to determine cause of metabolic acidosis identify and treat the underlying cause Simple acid-base disorders Table 13 demonstrates simple acid-base disorders in terms of the primary change in bicarbonate or carbon dioxide, the compensatory changes that occur and the effect on pH. By a simple rule of thumb in simple acid-base disorders the acid-base buffer pair change in the same direction. If they change in the opposite direction the disorder must be mixed. 65
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electro
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Foreword This book, ‘Basic Concep
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Table of Contents 1. Normal Physiol
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ever, contains large anions such as
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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
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: vide a simple description of the mo
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
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Page 114 and 115:
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
Page 134 and 135:
Stewart approach 63, 71 sympathetic
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electrolyte Therapy

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