13. Crystalloid VS Colloid
• Crystalloid:2-3 Blood loss
• Colloid: ~1:1 Blood loss
• Blood replacement: for Oxygen
carrier
14. Fluid and Electrolyte
therapy
• Fluid:Quatity:volume
• Electrolyte:Quality:composition
15. Replacement for what?
• Daily requirement:Fluid maintenance
• Fluid deficit:Already loss
• Third space loss from surgery
• Fluid for blood replacement
16. Daily requirement:Fluid
maintenance
• Sensible loss:kidney and GI
– Urine:800-1200 cc/day
• Insensible loss:skin and lung
– Skin:20-400 cc/day
– Lung:400-600 cc/day
– Insensible perspiration (cc)=B.W. (kg.)x15
• Total:1600-2000 cc/day
• I/O record
17. Daily requirement:Fluid
maintenance 1
• Holliday and Segar
• น้ําหนัก 10 Kg แรก = 100 cc/Kg
• 10-20 Kg ตอมา = 50 cc/Kg
• >20 Kg = 20 cc/Kg
• For 24 Hr. of fluid maintenance
18. Daily requirement:Fluid
maintenance 2
• Fluid maintenance in 1 Hr.
• น้ําหนัก 10 Kg แรก = 4 cc/Kg/Hr
• 10-20 Kg ตอมา = 2 cc/Kg/Hr
• >20 Kg = 1 cc/Kg/Hr
• Rate = cc/Hr
• Rate/4= drop/min
19. Daily requirement:Fluid
maintenance 3
• For NPO pt. before surgery
• 5% D/N/2 rate 1.5-2 cc/kg/hr
22. Daily requirement:Fluid
maintenance
• 5% D/N/2 1000 cc.+ Water 1000 cc.
• 5%D/N/2 2000 cc.
• 5% D/NSS 1000 cc.+ Water 1000 cc.
23. Fluid deficit,already loss
• Volume deficit assesment from
history taking and physical
examination
• Mild dehydration:3% B.W.
• Moderate dehydration:6% B.W.
• Severe dehydration:9% B.W.
24. STAGE 0-5% 5-10% 10-15%
Dehydration Dehydration Dehydration
Appearance Freshful Restless Semicomatose
Skinturgor Normal or slightly
Eyes Normal or sunken Sunken
Mucous membrane Dry red Very dry Very dry, cyanosis
H.R. 130 160
% B.W. loss 2-5 % 5-10 % > 10 %
Skin temperature Warmer Cold or warm Cold
Fontanelle (in Normal Maybe sunken Sunken
child)
25. อาการ Deficit (% body wt.)
Early Thirst 2%
Moderate 6%
Marked thirst
Dry mouth
Oliguria
Weakness
Malaise
Loss of skin turgor
Mental change
Severe 7-14 %
Severe mental change
Hallucination
Gross weakness
26. Fluid deficit,already loss
• Composition assesment:Fluid loss
from what?
• Vomitting?
• Diarrhea?
• NG-tube?
• T-tube?
29. Fluid deficit,already loss
• Diarrhea จะเลือกใช N/2+KCl 30 mEq/l
• Vomiting จะเลือกใช N/2+KCl 10 mEq/l
• NG tube ใช N/2+KCl 10 mEq
• T tube (ในการผาตัดทอน้ําดี) ใช LRL
30. Third space loss
• Volume:
– Major surgery:8 cc/kg/hr
– Moderate surgery:6 cc/kg/hr
– Minor surgery:4 cc/kg/hr
– OMFS:2-4 cc/kg/hr
• Composition:LRS,ARS
31. Blood loss therapy
• Acceptable blood loss (ABL)
• (Hct -30) x ปริมาณเลือดในรางกาย x 3/100
• < 1/3 ABL—LRS,ARS 2-3:1 of blood loss
• >1/3 ABL--LRS,ARS 2-3:1 of blood loss or
Albumin 1:1 of blood loss
• = ABL---Packed red cell(PRC) 0.5:1 of
blood loss
32. Fluid therapy during the
operation
• Maintenance
• Preoperative deficit
– ½ in first hour
– ¼ in second hour
– ¼ in third hour
• Third space loss
• Blood loss during the operation