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FLUID THERAPY

FLUID THERAPY. Nurul Sazwani. DehYdration. Definition : a state of negative fluid balance decreased intake increased output fluid shift. Signs & symptoms. appears unwell altered responsiveness, for example is irritable or lethargic decreased urine output pale or mottled skin

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FLUID THERAPY

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  1. FLUID THERAPY NurulSazwani

  2. DehYdration • Definition : a state of negative fluid balance • decreased intake • increased output • fluid shift

  3. Signs & symptoms • appears unwell • altered responsiveness, for example is irritable or lethargic • decreased urine output • pale or mottled skin • cold extremities • Headache, dizziness, fainting • Orthostatic hypotension • Thirst • Loss of appetite, nausea • paresthesia

  4. Suspected dehydration? • Fast! Capillary refill -normal< 2s • Poor skin turgor • Hypotension • Tachycardia • Shock

  5. Subjective test Laboratory investigations: • Do not routinely perform blood biochemistry. • Measure plasma sodium, potassium, urea, creatinine and glucose concentrations if: –intravenous fluid therapy is required or –there are symptoms or signs suggesting hypernatraemia. • Measure venous blood acid–base status and chloride concentration if shock is suspected or confirmed. • Urine specific gravity • Other tests may be done to determine the cause of the dehydration (for example, blood sugar level to check for diabetes).

  6. Rehydration! Questions? • 1.Which method of rehydration? • 2.How much fluid should patient receive? • 3.With what speed should the fluids be given? • 4.What type of solution?

  7. How much fluid? • Basic fluid need + • Fluid lost + • Extra fluid deficit

  8. How much fluid? • Basic fluid need: Depends on the weight (/24 hours): 1-10kg –100 mL / kg 11-20 kg –50 mL / each kg > 10 kg 20-70 kg –20 mL / each kg > 20 kg Over 70 -2500-3000mL /24 hours

  9. How much fluid? How much fluid did the patient loose? • Patients’ weight • Assess according to the table: up to 5% 6-10% >10%

  10. How much fluid? Extra fluid deficit • •Vomitting • •Diarrhoea • •Fever • •Tachypnoe for each episode of vomitting/ loose stool/ degree of fever≥ 38°C add additional 10ml/kg/24 hours

  11. TYPE OF SOLUTION • ORS – Oral rehydration solution • Milk? Fruit juice? Sodas? Carbonated beverages? Caffeinated drinks? Sports drinks?

  12. SPEED & TYPE OF FLUID GIVEN If intravenous fluid therapy is required for rehydration (and is not hypernatraemic at presentation): • use an isotonic solution such as 0.9% sodium chloride, or 0.9% sodium chloride with 5% glucose, for fluid deficit replacement and maintenance • speed of rehydration: 50% within the first 8 hours(bolus included) 50% within the remaining 16 hours

  13. !!!hypernatraemic dehydration!!!! Suspect hypernatraemicdehydration if there are any of the following: • jittery movements • increased muscle tone • hyperreflexia • convulsions • drowsiness or coma.

  14. !!!hypernatraemic dehydration!!!! If intravenous fluid therapy is required in hypernatraemic dehydration: • obtain urgent expert advice on fluid manageme • replace the fluid deficit slowly - typically over 48 hours • monitor the plasma sodium frequently, aiming to reduce it at a rate of less than 0.5 mmol/l per hour.

  15. Shock!!! • Treat suspected or confirmed shock with a rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution.

  16. The end

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