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1、FLUID AND ELECTROLYTE MANAGEMENT中山二院心胸外科熊利华1For surgical patients : Diseases, injuries, operative trauma, lack of alimentation metabolism of salt, water, other electrolytes2Total Body Water60% of body weigh50% of body weight 75% to 80% lean individual obese person 3Water ExchangeDrink10001300 Food 7
2、00 900 Metabolic water300Urine 8001500 Lung 350 Skin 500 Stool 250250025004Water ExchangeA patient deprived of all external access to water must still excrete a minimum of 500 to 800 ml. of urine per day in order to excrete the products of catabolism, Insensible loss of water occurs through the skin
3、 (75%) and the lungs (25%) and is increased by hypermetabolism, hyperventilation, and fever. 5Composition of UrineWaterNitrogen-containing material：urea、 uric acid、creatine、creatinine、amino acid and amonia。Organic compound：hippuric acid、 glucuronate、lactic acid、ethanedioic.Electrolyte：Cl-、Na 、K and
4、phosphate。 Little protein and sugar，positive in urine pathology。 6Three functional compartments of the body waterintracellular water 40%extracellular water 20%body weight 60% plasma 5%interstitial fluid 15%7Total blood volume of human bodyGenerally 8of body weight，About 5000 ml for an adult。increase
5、2325 in pregnancy women。 About 80 of total volume in circulationOther 20% stored in liver and spleen 8154mEq/l 154mEq/l153mEq/l 153mEq/l200 mEq/l 200 mEq/lCation AnionsNa+ 142 Cl- 103HCO3- 27SO4=PO4 3K+ 4 Ca+ 5 Mg+ 3Protein 16Organic acid 5Cation Anions Na+ 144 Cl- 114HCO3- 30SO4=PO4 3K+ 4 Ca+ 3 Mg+
6、 2 Protein 1Organic acid 5Cation Anions K+ 150 HPO4= SO4= 150HCO3- 10Na+ 10 Mg+ 40Protein 40Plasma Intestitial fluid Intracellular fluidChemical composition of body fluid compartment: 9Osmotic Pressure Depends on the number of particles present per unit volume . 1 mM NaCl =sodium +chloride, contribu
7、tes 2 mM, 1 mM Na2SO4=3 particles, contributes 3 mM. 1 mM glucose is equal to 1 mM of the substance. Normal Osmotic Pressure Cations(151) Anions(139) non electrolyte (10)300mmol/L(280 310mmol/L)10semipermeable membrane The cell wall maintained the differences in ionic composition between ICF and ECF
8、. The cell membranes are completely permeable to water11colloid osmotic pressureThe dissolved proteins in the plasma are primarily responsible for effective osmotic pressure between the plasma and the interstitial fluid compartments.12The effective osmotic pressureintracellular extracellular dissolv
9、ed proteins plasma interstitial fluid 13The effective osmotic pressure The difference of pressure between the ECF and ICF compartments induced by any substance that does not traverse the cell membranes freely. 14CLASSIFICATION OF BODY FLUID CHANGESThe disorders in fluid balance ：volume deficit or Ex
10、cessconcentration composition15Volume DeficitThe most common disorders leading to an ECF volume deficit include:1. losses of gastrointestinal fluids due to vomiting, nasogastric suction, diarrhea, fistula drainage. 2. sequestration of fluid in soft tissue injuries and infections, intra-abdominal and
11、 peritonitis, intestinal obstruction, and burns.16Volume ExcessGenerally secondary to renal insufficiency. Both the plasma and the interstitial fluid volumes are increased.17CONCENTRATION CHANGESECF: Na+ represent 90% of particles concentration. Hyponatremia and hypernatremia can be diagnosed by cli
12、nical manifestations, laboratory tests.18Mechanism of HyponatremiaWater intake excessSodium intake deficientRenal inadequacyVomite, suction19Hyponatremia Asymptomatic until the serum sodium level falls 120 mmol per liter. Acute symptomatic hyponatremia: CNS signs: Increased intracranial pressure; ti
13、ssue signs of excessive intracellular water.20Hyponatremia: (Water intoxication ) serum sodium level less than 120 mmol/L CNS: Moderate severe Muscle twitching Convulsions Hyperactive tendon reflexes Loss of reflexes increased intracranial pressureCardioVascular: Bp change Tissue: increased salivati
14、on Watery diarrhea Renal: Oliguria progressing to anuria Metabolic: None 21Mechanism of HypernatremiaWater intake deficientDiseases of digestive tractExcess loss waterexcess perspirationVomite, diarrhea, suction22Hypernatremia: (Water deficit ) serum sodium level greater than 150 mmol/LCNS: Moderate severe Restlessness Delirium Weakness Maniacal behavior CardioVascular: Tachycardia, HypotensionTissue: Decreased saliva and tears Dry and sticky mucous membranes Renal: Oliguria Metabolic: Fever 23MIXED VOLUME AND CONCENTRATION ABNORMALITIE
