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1、1,FLUID AND ELECTROLYTE MANAGEMENT,中山二院心胸外科 熊利华,2,For surgical patients : Diseases, injuries, operative trauma, lack of alimentation metabolism of salt, water, other electrolytes,3,Total Body Water 60% of body weigh 50% of body weight 75% to 80% lean individual obese person,4,Water Exchange,Drink100
2、01300 Food 700 900 Metabolic water300,Urine 8001500 Lung 350 Skin 500 Stool 250,2500,2500,5,Water Exchange A 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 occur
3、s through the skin (75%) and the lungs (25%) and is increased by hypermetabolism, hyperventilation, and fever.,6,Composition of Urine,Water Nitrogen-containing material：urea、uric acid、creatine、creatinine、amino acid and amonia。 Organic compound：hippuric acid、glucuronate、lactic acid、ethanedioic. Elect
4、rolyte：Cl-、Na 、K and phosphate。 Little protein and sugar，positive in urine pathology。,7,Three functional compartments of the body water,intracellular water 40%,extracellular water 20%,body weight 60%,plasma 5%,interstitial fluid 15%,8,Total blood volume of human body,Generally 8of body weight， About
5、 5000 ml for an adult。 increase2325 in pregnancy women。 About 80 of total volume in circulation Other 20% stored in liver and spleen,9,Plasma Intestitial fluid Intracellular fluid,Chemical composition of body fluid compartment:,10,Osmotic Pressure Depends on the number of particles present per unit
6、volume . 1 mM NaCl =sodium +chloride, contributes 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),11,semipermeable membrane The cell wall maintained the dif
7、ferences in ionic composition between ICF and ECF. The cell membranes are completely permeable to water,12,colloid osmotic pressure The dissolved proteins in the plasma are primarily responsible for effective osmotic pressure between the plasma and the interstitial fluid compartments.,13,The effective osmotic pressure,intracellular,extracellular dissolved proteins,plasma,interstitial fluid,14,
