As diarrheal fluid is rich in sodium, bicarbonate and potassium diarrhea leads to hypokalemic hyperchloremic metabolic acidosis with dehydration. Mild dehydration: up to 5% total body water (2 to 3L in 70kg man) Normal mental state, dry mucous membranes, usually thirsty, blood pressure and heart rate normal, lower than normal urine output and skin turgor almost normal. Moderate dehydration: 5-10% total body water (4 to 5 L in 70kg man) Disinterest in surrounding, can be drowsy, increased heart rate and respiratory rate, orthostatic hypotension, decreased skin turgor and reduced urine output Severe dehydration: 10-15% total body water (7 to 8 L in 70kg man) Reduced conscious level, fast heart rate, low blood pressure, respiratory distress and oliguria/anuria

1. Dr. Lokesh Garg
MBBS MD.(Med.)
SANTOSH HOSPITAL
YAMUNA NAGAR

2. Why to discuss fluid Therapy

3. Why patients need intravenous fluid
therapy ?
Patient needs IV fluid therapy for
Maintenance ( to supply daily needs ) ,
Replacement ( to replace deficit and on-going losses )
Resuscitation ( to correct an IV or extracellular deficit )

4. Planning and preparing prescription of
intravenous fluids

5. Step 1 : Assessment

6. Step 2:
Calculation of volume of intravenous fluids

7. Step 3 :
Selection of intravenous fluids

8. Step 4 :
Determine rate of fluid administration

9. How much fluid to give ?

10. Assessment of volume status
Mild dehydration: up to 5% total body water (2 to 3L in 70kg man)
Normal mental state, dry mucous membranes, usually thirsty, blood pressure and heart rate
normal, lower than normal urine output and skin turgor almost normal.
Moderate dehydration: 5-10% total body water (4 to 5 L in 70kg man)
Disinterest in surrounding, can be drowsy, increased heart rate and respiratory rate,
orthostatic hypotension, decreased skin turgor and reduced urine output
Severe dehydration: 10-15% total body water (7 to 8 L in 70kg man)
Reduced conscious level, fast heart rate, low blood pressure, respiratory distress and
oliguria/anuria

11. Which fluid to give ?
Intravenous fluids to be infused in a given patient is selected on the basis of
Composition of IV fluids .
Underlying etiology and presence of electrolyte and acid-base
disorder.
Selection of intravenous fluids (considering its composition)

12. Sodium concentration of various
intravenous fluids
Intraveno
us fluids
Isotonic
saline
Ringer's
lactate
5% / 10%
dextrose
Isolyte-G Isolyte-M Isolyte-P
Na (mq/L) 154 130.0 25 63 40 25

13. Potassium concentration of various
intravenous fluids
Intraveno
us fluids
Ringer's
lactate
Isolyte-GIsolyte-M Isolyte-P
k(mEq/L) 4.017.035.0 20.0
KCl (15%)Amp
20 mEq/10 ml

14. Characteristics of intravenous fluids
Characteristic Intravenous fluids Characteristic Intravenous fluids
Most physiological RL Glucose free Saline, RL
Rich in sodium NS,DNS,RL Sodium free Dextrose solutions
Rich in chloride NS,DNS,Iso-G Potassium free NS/DNS,dextrose solution
Rich in potassium Iso-M,P and G Avoid in liver failure RL, Iso-G, 5% D
Corrects acidosis RL, all isolyte Except Iso-G Avoid in renal failure NS, RL, all isolyte
Corrects alkalosis Isolyte-G, NS Provides phosphorous Isolyte-M

15. Selection of intravenous
fluid in common clinical
problems

16. Fluid therapy in hypovolemic shock :

17. Selection of intravenous solution for initial
treatment of hypovolemic shock

18. Avoid all isolytes

19. Isotonic saline is most preferred

20. Ringer’s lactate ( RL)

21. Colloids , albumin, blood products
most effective agents

22. Fluid Therapy in Diarrhea

23. Fluid Therapy in Diarrhea
Patients with severe dehydration
and shock need IV fluid therapy
RL is most preferred IV fluid to
correct dehydration

24. Fluid therapy in vomiting
Vomiting leads to hypokalemic
hyperchloremic metabolic alkalosis with
dehydration.
Most preferred IV fluid to correct dehydration
due to vomiting is isotonic saline (NS)

25. Fluid therapy in initial phase of stroke
Avoid 5% dextrose –
• it is hypotonic fluid and increases brain edema
• Leads hyperglycemia and enhances brain injury
Isotonic saline (NS) is the ideal IV fluid

26. Take Home message
Clinical disorder Ideal initial fluid Clinical disorder Ideal initial fluid
Hypovolemic shock NS,RL Burns Ringer’s lactate
Diarrhea Ringer’s lactate Intraoperative Ringer’s lactate
Vomiting Isotonic saline Starvation deficit 5% dextrose
Diabetic ketoacidosis Isotonic saline Hypokalemia Isolyte-M, KCl drip
Adult maintenance Isolyte-M SIADH 3%NaCl + IV frusemide
Post TURP NS, Avoid 5% D Stroke, neuro surg. NS. Avoid dextrose sol

27. Thank you
Questions ?