FLUID AND ELECTROLYTE BALANCE

PRESENTER: Dr. SIYUM MATHEWOS(OMFS-RI)

MODULATOR: DR. DEREJE (OMFS, CONSULTANT) 1
OUTLINE
• Objectives
• Introduction
• Fluid compartments
• Composition of fluid compartments
• Concentration changes and it’s management
• Acid-base balance
• Fluid and Electrolyte therapy( Preop, Intraop and Postop,)
• Special Considerations for the Postoperative Patient
• Summery
• References
2
Objectives
 To understand body fluid compartments, composition and
concentration
 To understand fluid types and their use
 To assess body fluid volume and concentration changes, to manage
them properly for better recovery of surgical patient.
 To diagnose acid base disturbunces and their management.

3
INTRODUCTION

 Fluid and electrolyte management is paramount to the care of the

surgical patient.
 Changes in both fluid volume and electrolyte composition occur
preoperatively, intraoperatively, and postoperatively, as well as in
response to trauma and sepsis.

4
BODY FLUIDS

Total Body Water

 Water constitutes approximately 50% to 60% of total body weight.
 The relationship between total body weight and total body water
(TBW) is relatively constant for an individual and is primarily a
reflection of body fat.
 Lean tissues such as muscle and solid organs have higher water
content than fat and bone.
 As a result, young, lean males have a higher proportion of
body weight as water than elderly or obese individuals.
5
Cont’d
 In an average young adult male, TBW accounts for 60% of total body
weight, whereas in an average young adult female, it is 50%.
 The lower percentage of TBW in females correlates with a higher
percentage of adipose tissue and lower percentage of muscle mass in
most.
 The highest percentage of TBW is found in newborns, with
approximately 80% of their total body weight comprised of water.

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Total body water cont…

Figure. Water content varies in different body organs and tissues, from as
little as 8 percent in the teeth to as much as 85 percent in the brain.
Fluid Compartments

 TBW is divided into three functional fluid compartments:

 Plasma
 Extravascular interstitial fluid
 Intracellular fluid
 The ECF(plasma and IF) compose about 1/3rd of TBW, 20% of the total body weight
(Plasma 5% of body weight and interstitial fluid 15%),
 The ICF composes the 2/3rd of TBW and 40% of an individual’s total body weight, with
the largest proportion in the skeletal muscle mass.

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Body fluid compartments cont…

9
Composition of Fluid Compartments

 The ECF compartment is balanced between the principal cation(Na+)

and the principal anions(Cl- and HCO3- )
 The ICF compartment is composed primarily of the cations (K+ &
Mg2+) and the anions (phosphate and sulfate, and proteins)

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Body fluid composition cont…

Chemical composition of body fluid compartments

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12
Fluid and solute movements between
compartments
 Fluid Movement between Compartments
 This is caused by CHP and Colloid COP
 Capillary Hydrostatic pressure is the force exerted by a fluid against a wall,
forcing plasma and nutrients out of the capillaries into surrounding tissues.
 Colloid osmotic pressure in blood is a “constant” pressure primarily
produced by circulating albumin causing reabsorption of fluid and cellular
wastes near the venous end of the capillary (COP is greater than CHP).

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 Cont…

Figure 6. Net filtration occurs near the arterial end of the capillary since capillary hydrostatic pressure (CHP) is greater
than blood colloidal osmotic pressure (BCOP). There is no net movement of fluid near the midpoint of the capillary since
CHP = BCOP. Net reabsorption occurs near the venous end of the capillary since BCOPis greater than CHP. 14
Cont…
 Solute Movement between Compartments
 The movement of some solutes between compartments is
 Active transport
 Which consumes energy in the form of ATP against its concentration gradient (Na +/K+-
pump)
 Passive transport.
 Passive transport of a molecule or ion depends on its ability to pass through the
membrane, as well as the existence of a concentration gradient that allows the molecules
to diffuse from an area of higher concentration to an area of lower concentration.

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 Body fluid changes cont…

Normal Exchange of Fluid and

Electrolytes
 Daily water gain:
 Sensible: oral fluids & solid foods
 Insensible: from metabolism
 Daily water losses include:
 Sensible: through urine, stool &
Sweating
 Insensible: through skin(75%) &
lungs(25%)

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Cont’d
Classification of Body Fluid Changes
 Disorders in fluid balance may be classified into three general
categories:
I. Disturbances in volume,
II. Disturbances in composition,
III. Disturbances in concentration
 Although each of these may occur simultaneously, each is a separate
entity with unique mechanisms demanding individual correction.

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Cont…
 Isotonic gain or loss of salt solution results in ECF volume changes,
with little impact on ICF volume.
 If free water is added or lost from the ECF, water will pass between
the ECF and ICF until solute concentration or osmolarity is equalized
between the compartments.

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 I. Disturbances in Fluid volume
ECF volume deficit
 Is the most common fluid disorder
in surgical patients, acute or
chronic.
 Cause: nasogastric suction,
vomiting, diarrhea and
enterocutaneous fistula
Signs and symptoms: from the
table
RX: fluid replacement usually with
an isotonic crystalloid, If
symptomatic, (0.45% saline or
lactated Ringer’s solution
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 Cont…
ECF volume excess
 Causes: Iatrogenic or secondary
to: renal dysfunction, congestive
heart failure and cirrhosis
 Signs and Symptoms: table
 RX: treating underlining cause,
restricting salt intake, diuretics
dialysis, paracentesis

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Volume Control
 Volume changes are sensed by both
osmoreceptors and baroreceptors.
 Osmoreceptors are sensers detecting
changes in fluid osmolality and drive
changes in thirst and diuresis through
the kidneys.
 Baroreceptors detect changes in
pressure and circulating volume and
located in the aortic arch and carotid
sinuses(by neural & hormonal(RAAS,
atrial natriuretic peptide, and renal
prostaglandins).

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 II. Concentration Changes
Sodium abnormalities
 Hyponatremia
 Is a condition of excess water relative to Na+ or a serum [Na+] <138 mEq/L.
Causes
 Depletional ( Intake or loss of Na+-containing fluids).
 Dilutional (excess EC- water(excessive oral H2O intake, iatrogenic (IV) excess free
H2O administration, drugs can cause water retention in elderly)
 Excess of solute relative to free water and extreme elevations in plasma lipids and
proteins can result in hyponatremia

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 Hyponatremia Cont…
Treatment
Clinical manifestations
 Most cases, by free water restriction
 If severe, the administration of
sodium.
 If neurologic symptoms are present,
3% hypertonic saline to raise [Na+] by <
1 mEq/L/h until the serum Na+ level
reaches 130 mEq/L or neurologic
symptoms are improved.

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 Hypernatremia
 Hypernatremia is defined as plasma [Na+ ] >145 mEq/L.
Cause
 A loss of free water or
 A gain of sodium.
 Hypernatremia may be hypervolemic, normovolemic and hypovolemic.
 Hypervolemic hypernatremia(urine [Na+] of >20 mEq/L, and urine
osmolarity of >300 mOsm/L).
 Hypovolemic hypernatremia(urine Na+ concentration is <20 mEq/L and
urine osmolarity is <300 to 400 mOsm/L) ---> tachycardia, orthostasis, and
hypotension)

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 Hypernatremia cont…
 Signs and Symptoms Treatment
 Treatment usually consists of
treatment of the associated water
deficit.
 In hypovolemic patients, volume
should be restored with normal
saline.
 Once adequate volume has been
achieved, the water deficit is replaced
using a hypotonic fluid such as 5%
dextrose in ¼ NS.
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 Potassium Abnormalities
Etiology
 The average dietary intake of K is
approximately 50 to 100 mEq/d.
 ECF [K+] is maintained within a
narrow range, by renal excretion.
 K+ located within the ECF
compartment, is critical to cardiac
and neuromuscular function.

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 Potassium abnormality cont…
 Hyperkalemia: is when [K+] >5.0
 Symptoms mEq/L. Treatment

Hyperkalemia/increased serum level

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 Potassium abnormality cont…
 Hypokalemia : when [K+] < 3.5 mEq/L
 Hypokalemia is much more common than hyperkalemia in the surgical patient.

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 Hypokalemia cont…
Symptoms  Treatment
 The failure of normal
contractility of GI smooth
muscle, skeletal muscle, and
cardiac muscle; resulting in:
 Ileus, constipation,
weakness, fatigue,
diminished tendon reflexes,
paralysis, and cardiac arrest.

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Calcium Abnormalities
 The vast majority of the body’s calcium is contained within the bone
matrix, with <1% found in the ECF.
 Serum calcium is distributed among three forms: protein found
(40%), complexed to phosphate and other anions (10%), and ionized
(50%), which is responsible for neuromuscular stability and can be
measured directly.

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Calcium Abnormalities Cont…
 The organs involved in the homeostasis of calcium are bones,
kidneys, and the intestines, where as the major determinates are
three hormones and one receptor.
 Active vitamin D3): promotes Ca2+ absorption from intestine.
 Parathyroid hormone (PTH): stimulates bone demineralization by activating
osteoclasts & reabsorption from the kidneys.
 Calcitonin: It inhibits the activity of osteoclasts and thus bone resorption to
reduce serum [Ca2+].
 Ca2+-sensing receptor ( PT, Kidney, Thyroid, bone)

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  Hypercalcemia

 Is defined as a serum calcium level above the normal range of 8.5 to 10.5 mEq/L
or an increase in the ionized calcium level above 4.2 to 4.8 mg/dL.
 Causes
 Primary hyperparathyroidism in
the outpatient setting, stimulating
calcium resorption from bone and
decreasing renal excretion of
calcium.
 Malignancy is the most common
cause of hypercalcemia in
hospitalized patients and is due to
increased bone resorption or
decreased renal excretion.

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Cont…
 Symptoms

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Hypercalcemia Cont…
Treatment
 Administer 0.9% NS at 500 to 1000 mL/h for 2 to 4 hours (3 to 4 L over the
first 24 hours, then 2 to 3 L /24 hours until a urine output of 2 L/d is
achieved.)
 Furosemide(20 to 40 mg): to promote a diuresis of 150 to 200 mL/h- -->
increases the calciuric effect
 Corticosteroids: to decrease mobilization of [Ca2+] from bone through
reduction of osteoclastic activity.
 Prednisone,1 to 2 mg/kg, PO, or hydrocortisone, 200 to 300 mg, IV initial dose, in
Addison’s disease or in steroid-responsive malignancies.
 For patients with severe, refractory hypercalcemia, dialysis is an option.

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Hypocalcemia cont…
 Causes
 Hypocalcemia is
defined as a serum
calcium level below 8.5
mEq/L or a decrease in
the ionized calcium level
below 4.2 mg/dL.

35
Hypocalcemia cont…
 Signs and symptoms Treatment
 Asymptomatic: by oral or IV calcium.
 Acute symptomatic should be treated
with IV 10% calcium gluconate.
 Symptomatic patients after thyroid or
parathyroid surgery are often treated
with parenteral Ca2+.
 Associated deficits in magnesium,
potassium, and pH must also be
corrected.
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Phosphorus Abnormalities.

 Phosphorus is the primary intracellular divalent anion and is

abundant in metabolically active cells.
 Phosphorus is involved in energy production during glycolysis and is
found in high-energy phosphate products such as ATP.
 Serum phosphate levels are tightly controlled by renal excretion.

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  Hyperphosphatemia

 Hyperphosphatemia is defined as serum [PO43–] >4.5 milligrams/dL.

 Causes

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Cont…
 Clinical manifestations
 Most cases of hyperphosphatemia are asymptomatic,
 But significant prolonged hyperphosphatemia can lead to metastatic
deposition of soft tissue calcium-phosphorus complexes.
 Treatment
 Phosphate binders such as sucralfate or aluminum-containing antacids
can be used to lower serum phosphorus levels.
 Calcium acetate tablets also are useful when hypocalcemia is
simultaneously present.
 Dialysis usually is reserved for patients with renal failure.

39
  Causes
 Hypophosphatemia
 Hypophosphatemia is
defined as serum [PO43–]
<2.5 mg/dL, but severe
symptoms may not occur
until the [PO43–] level
drops to <1 milligram/dL.

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 Hypophosphatemia cont…
 Symptoms and signs  Treatment

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Magnesium Abnormalities.

 Magnesium is the fourth most common mineral in the body and, like
potassium, is found primarily in the intracellular compartments.
 Approximately ½ of the total body content of 2000 mEq is
incorporated in bone and is slowly exchangeable.
 Of the fraction found in the extracellular space, 1/3rd is bound to
serum albumin.
 The normal dietary intake is approximately 20 mEq/d and is excreted
in both the feces and urine.
 The magnesium ion is essential for proper function of many enzyme
systems.
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  Hypermagnesemia
 Hypermagnesemia is rare but can be seen with severe renal insufficiency
and parallel changes in potassium excretion.

43
 Cont…
Signs and symptoms

44
Hypermagnesemia cont…
 Treatment
 Treatment consists of measures to:
 Eliminate exogenous sources of magnesium,
 Correct concurrent volume deficits, and
 Correct acidosis if present.
 To manage acute symptoms, calcium chloride (5 to 10 mL) should be
administered to immediately antagonize the cardiovascular effects.
 If elevated levels or symptoms persist, hemodialysis may be
necessary.

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  Hypomagnesemia
 Magnesium depletion is a
common problem in
hospitalized patients,
particularly in the critically ill.
 The kidney is primarily
responsible for magnesium
homeostasis through regulation
by calcium/magnesium
receptors on the renal tubular
cells that respond to serum
magnesium concentrations.
 Causes

46
 Hypomagnesemia cont…

 Signs and Symptoms

 Hypomagnesemia is
important not only because
of its direct effects on the
nervous system but also
because it can produce
hypocalcemia and lead to
persistent hypokalemia.

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Hypomagnesemia cont…
 Treatment
 Oral repletion if asymptomatic and mild.
 Depending on severity and clinical symptoms, IV repletion is
indicated.
 For those with severe deficits (<1.0 mEq/L) and symptomatic, 1 to 2 g of
magnesium sulfate IV over 15 minutes given.

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Cont…

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Acid-Base Balance

Acid-Base Homeostasis.
 The pH of body fluids is maintained within a narrow range despite
large acid load produced as a by-product of metabolism.
 This endogenous acid load is efficiently neutralized by buffer systems
and ultimately excreted by the lungs and kidneys.
 Important buffers include:
 The intracellular proteins and phosphates and the extracellular
bicarbonate–carbonic acid system.

50
Cont…
 Compensation for acid-base derangements can be by:
 Respiratory mechanisms (for metabolic derangements) or
o Changes in ventilation in response to metabolic abnormalities are mediated by
hydrogen sensitive chemoreceptors found in the carotid body and brain stem,
(acidosis stimulates the chemoreceptors to increase ventilation, whereas
alkalosis decreases the activity of the chemoreceptors and thus decreases
ventilation(fast process))
 Metabolic mechanisms (for respiratory derangements).
o The kidneys provide compensation for respiratory abnormalities by either
increasing or decreasing bicarbonate reabsorption in response to respiratory
acidosis or alkalosis, respectively(slow process)

51
Cont…

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 Metabolic Derangements
 Metabolic acid-base disorders reflect primary changes in [HCO3–]
 Metabolic Acidosis
 When PH<7.35 and PaCO2< 40mmHg and bicarbonate level < 24 mEq/L)
 Causes
 An increased intake of acids(ethylene glycol, salicylates, or methanol)
 An increased generation of endogeneous acids
o β-Hydroxybutyrate and acetoacetate in ketoacidosis
o Lactate in lactic acidosis
o Organic acids in renal insufficiency
An increased loss of bicarbonate

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 Metabolic acidosis cont…
 The body responds by several mechanisms:
Producing buffers (extracellular bicarbonate and intracellular buffers),
Increasing ventilation (Kussmaul’s respirations), and
Increasing renal reabsorption and generation of bicarbonate.
 Increasing renal secretion of H+ and thus increasing urinary excretion of NH4+ (H+ +
NH3+ = NH4+).
 Symptoms of metabolic acidosis
Abdominal pain, headache, nausea with or without vomiting, and generalized
weakness, and dyspnea(because acidosis stimulates the respiratory center).

54
Cont…
 Treatment
 Since a common cause of severe metabolic acidosis in surgical
patients is lactic acidosis due to inadequate tissue perfusion and
hypoxia; Rx is to restore perfusion with volume resuscitation rather
than to attempt to correct the abnormality with exogenous
bicarbonate.

55
Metabolic alkalosis cont…

 Metabolic Alkalosis (PH>7.45 and PaCO2 >40mmHg)

 Etiology
 Loss of fixed acids
 Gain of bicarbonate
 Hypochloremic and hypokalemic metabolic alkalosis can occur from
isolated loss of gastric contents in infants with pyloric stenosis or
adults with duodenal ulcer disease.

56
Cont…
 Symptoms
 Generalized weakness, dizziness, myalgia, palpitations, nausea with or
without vomiting, paresthesias, and possibly muscle spasm or
twitching.
Treatment
 Replacement of the volume deficit with isotonic saline and then
potassium replacement once adequate urine output is achieved.

57
 Respiratory Derangements
 Respiratory acid-base disorders are due to primary changes in Pco2,
 Under normal circumstances, blood Pco2 is tightly maintained by alveolar
ventilation, controlled by the respiratory centers in the pons and medulla
oblongata.

 Respiratory Acidosis:
 Is defined by alveolar hypoventilation
and is diagnosed when the Pco2 is
greater than the expected value ( PH<
7.35 & Pco2 >40mmHg
 Etiology

58
Respiratory Acidosis cont…
Symptoms
 Fatigue or drowsiness, becoming tired easily, confusion, shortness of
breath, sleepiness and headache.
Treatment
 Rx is directed at the underlying cause.
 Measures to ensure adequate ventilation should be initiated.

59
Respiratory Alkalosis

 In the surgical patient, most cases of respiratory alkalosis are acute

and secondary to alveolar hyperventilation.
 Etiology
 It is caused by conditions that stimulate respiratory centers, including CNS
tumors or stroke, infections, pregnancy, hypoxia, and toxins (e.g., salicylates).
 Pain, anxiety, and neurologic disorders, including central nervous system
injury and assisted ventilation.
 Drugs such as salicylates, fever, gram-negative bacteremia, thyrotoxicosis, and
hypoxemia are other possibilities.

60
Cont…
 Symptoms
 Arrhythmias, paresthesias, muscle cramps, and seizures.
 Treatment
 Should be directed at the underlying cause, but direct treatment of the
hyperventilation using controlled ventilation may also be required.

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FLUID AND ELECTROLYTE THERAPY

Parenteral Solutions
 A number of commercially available electrolyte solutions are available
for parenteral administration.
 The type of fluid administered depends on:
The patient’s volume status and
The patient’s type of concentration or compositional abnormality present.

62
Cont…

The most commonly used solutions 63

Cont…
 Plasma-Lyte, lactated Ringer’s solution, and normal saline are
considered isotonic and are useful in replacing GI losses and
correcting extracellular volume deficits.
 Plasma-Lyte
 Is the crystalloid preparation that most closely resembles the electrolyte
composition of human plasma.
 In also contains a number of additional buffers that create a favorable profile
for addressing acidosis.
 These characteristics have resulted it as one of the most popular isotonic
fluids for use in surgery.

64
Cont…
 Lactated Ringer’s
 Is slightly hypotonic in that it contains 130 mEq of lactate.
 Lactate is used rather than bicarbonate because it is more stable in IV fluids
during storage.
 It is converted into bicarbonate by the liver after infusion.

65
Cont…
 Sodium chloride
 Is mildly hypertonic( containing 154 mEq of Na+ and 154 mEq of Cl-).
 The high chloride concentration imposes a significant chloride load on the
kidneys and may lead to a hyperchloremic metabolic acidosis.
 Sodium chloride is an ideal solution, for correcting volume deficits associated
with hyponatremia, hypochloremia, and metabolic alkalosis.

66
Cont…
Less concentrated sodium solutions, such as 0.45% sodium chloride,
 Are useful:
 For replacement of ongoing GI losses as well as
 For maintenance fluid therapy in the postoperative period.
 Dextrose is always added to solutions containing <0.45% sodium
chloride:
 To maintain osmolality and thus prevent the lysis of RBCs that may occur
with rapid infusion of hypotonic fluids.

67
Alternative Resuscitative Fluids

 A number of alternative solutions for volume expansion and

resuscitation are available.
Hypertonic saline solutions (3.5% and 5%)
 Used for correction of severe sodium deficits.
Hypertonic saline (7.5%)
 Used for patients with closed head injuries to increase cerebral
perfusion and decrease intracranial pressure, thus decreasing
brain edema.

68
 Cont…
Colloids
 Due to their molecular weight, they are confined to the intravascular space,
hence they are plasma volume expansion.
 However, under conditions of severe hemorrhagic shock, colloids may enter the
interstitial space, which can worsen edema and impair tissue oxygenation.
 Major types of colloids are: albumin, dextrans, hetastarch, and gelatins
 Taken together, the use of colloid for resuscitation of critically ill and surgical
patients has limited application.

69
Cont…

70
Preoperative Fluid Therapy

 The maintenance fluids are those fluids that are required in healthy
individual who may be under orders to receive nothing by mouth for
some period before the time of surgery.
 This does not, however, include replenishment of a preexisting deficit
or ongoing fluid losses.
 The following is a frequently used formula for calculating the volume
of maintenance fluids in the absence of preexisting abnormalities:
For the first 0–10 kg ---> Give 100 mL/kg/day
For the next 10–20 kg ---> Give an additional 50 mL/kg/day
For weight >20 kg ---> Give an additional 20 mL/kg/day

71
Cont…

72
Cont…
 Acute volume deficits should be corrected as much as possible before
the time of operation.
 Once a volume deficit is diagnosed, fluid replacement should be
instituted, usually with an isotonic crystalloid,

73
Cont…
 Resuscitation should be guided by the reversal of the signs of volume
deficit, such as:
 Restoration of acceptable values for vital signs,
 Maintenance of adequate urine output (0.5 to 1 mL/kg/hour in an adult),
 Correction of base deficit.

74
Cont…
 If symptomatic electrolyte abnormalities accompany volume deficit,
acute symptom is relieved before surgical intervention.
 Severe hypernatremia associated with a volume deficit, corrected by
slowly administering with 0.45% saline or even lactated Ringer’s
solution rather than 5% dextrose alone.
 This will safely and slowly correct the hypernatremia while also
correcting the associated volume deficit.

75
Intraoperative Fluid Therapy

 With the induction of anesthesia, compensatory mechanisms are

lost, and hypotension will develop if volume deficits are not
appropriately corrected before the time of surgery.
 Hemodynamic instability during anesthesia is best avoided by
 Correcting known fluid losses,
 Providing adequate maintenance fluid therapy preoperatively.
Replacing ongoing losses,

76
Cont…
 Although no accurate formula can predict intraoperative fluid needs,
replacement of ECF during surgery often requires 500 to 1000 mL/h of
a balanced salt solution to support homeostasis.

77
Postoperative Fluid Therapy

 Postoperative fluid therapy should be based on:

 The patient’s current estimated volume status and
 The patient’s projected ongoing fluid losses.
 Any deficits from either preoperative or intraoperative losses should
be corrected, and ongoing requirements should be included along
with maintenance fluids.

78
 Cont…
 In the initial postoperative period, an isotonic solution should be
administered.
 The adequacy of resuscitation should be guided by the restoration of:
Acceptable values for vital signs, urine output and, base deficit or lactate.

79
Cont…
 After the initial 24 to 48 hours,
o Fluids can be changed to 5% dextrose in 0.45% saline in patients unable to
tolerate enteral nutrition.
o If normal renal function and adequate urine output are present, potassium
may be added to the IV fluids.

 Daily fluid orders should begin with assessment of the patient’s volume
status and assessment of electrolyte abnormalities.

80
Special Considerations for the Postoperative Patient

 Volume excess
 Is a common disorder in the postoperative period.
 The administration of isotonic fluids in excess of actual needs due to the
overestimation of ongoing GI losses that are difficult to measure accurately
may result in excess volume expansion.
 The earliest sign of volume overload is weight gain.

81
Cont…
 The average postop patient who is not receiving nutritional support
should lose approximately (0.11 to 0.23 kg/d) from catabolism.
 Volume deficits
 Can be encountered in surgical patients if:
o Preoperative losses were not completely corrected,
o Intraoperative losses were underestimated, or
o Postoperative losses were greater than appreciated.

82
Cont…
The clinical manifestations include
o Tachycardia,
o Orthostasis,
o Oliguria
o Hemoconcentration.
Treatment will depend on the amount and composition of fluid lost.
 In most cases of volume depletion, replacement with an isotonic
fluid will be sufficient while alterations in concentration and
composition are being evaluated.

83
 Summery
 Proper management of fluid and electrolytes facilitates crucial homeostasis
that allows cardiovascular perfusion, organ system function, and cellular
mechanisms to respond to surgical illness.
 Although difficult to quantify, a deficiency in the functional extracellular fluid
compartment often requires resuscitation with isotonic fluids in surgical and
trauma patients.
 Alterations in the concentration of serum sodium have profound effects on
cellular function due to water shifts between the intracellular and
extracellular spaces.

84
 Cont…
 Different rates of compensation between respiratory and metabolic
components of acid-base homeostasis require frequent laboratory
reassessment during therapy.
 Most acute surgical illnesses are accompanied by some degree of volume
loss or redistribution.
 Consequently, isotonic fluid administration is the most common initial
intravenous fluid strategy, while attention is being given to alterations in
concentration and composition.

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References

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THANK YOU!!!

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