Fluid and Electrolyte Management in Surgery

Jul 15, 2024

Fluid and Electrolyte Management in Surgery

Introduction

  • Speaker: Dr. Eric Pearson
  • Focus on fluid and electrolytes management in surgery
  • Relevant for medical students, residents, fellows, and surgeons preparing for board exams
  • Video covers basics and advanced concepts to build a solid foundation

Previous Content Recap

  • Recent Video: Surgical Nutrition (TPN indications and design)
  • Case Study: 25-year-old male in surgical ICU, needs TPN due to bowel discontinuity
    • **TPN Design Considerations: Fluid & Energy Needs: Fluid First (4-1 rule)"
    • 30 Kcal/Kg for energy; 60% carbs, 30% lipids (omega-3), 1-1.5 g/kg protein
    • Add vitamins, micronutrients
    • Ongoing monitoring: blood pressure, heart rate, urine output, indirect calorimetry (RQ)

Fluid and Electrolyte Basics

  • Importance: Fundamental to daily patient care in surgery
  • Focus Areas: Fluid compartments, electrolyte disturbances, and correction methods

Fluid Compartments

  • Total Body Water (TBW):
    • ~60% in adults, varies by age and sex
    • Divides into Intracellular (40%) and Extracellular (20%)
      • Extracellular further divides into Interstitial (15%) and Plasma (5%)
    • Intracellular: High in potassium (primary cation)
    • Extracellular: High in sodium (primary cation), low potassium

Fluid Distribution

  • Fluids Distribution Across Body Compartments
    • D5 Water: Distributes across total body water (TBW)
    • Normal Saline: Distributes across extracellular volume
    • 5% Albumin: Stays within plasma volume (5% TWA)

Clinical Scenario: Fluid Replacement Calculation

  • Scenario: 60-year-old male with hematemesis
    • Lost 1 liter of blood
    • Fluid replacement needed: how much D5 Water, Normal Saline, 5% Albumin?
  • Calculations:
    • D5 Water: 12 liters
    • Normal Saline: 4 liters
    • 5% Albumin: 1 liter

Obligatory Fluid and Electrolyte Losses

  • Fluid Losses:
    • Urine: 0.5-1 ml/kg/hr
    • GI: 100-200 ml/day
    • Insensible: 8-12 ml/kg/day (varies with conditions like temperature)
  • Daily Maintenance: 4-2-1 rule
    • Fluids: Estimation based on BNFL principles
    • Electrolytes: Sodium 100-250 meq/day, Potassium 15-20 meq/day
    • Fluid choices for replacement (e.g., normal saline for NG tube losses)

Perioperative Fluid Considerations

  • Considerations: Blood loss, fluid sequestration, GI losses, and drains
    • Example: Different operations affect extra vascular fluid sequestration
    • Maintenance fluid adjusted based on individual patient's need and environmental factors

Specific GI Secretions and Corresponding Fluid Replacement

  • GI Fluid Compositions: Different sections secrete different fluid volumes with distinct compositions
  • Replacement Tips: Match fluid composition (e.g., stomach losses with normal saline)

Conclusion

  • Review Available: Check out Citizen Surgeon for free resources and review sheets
  • Engage: Subscribe, ask questions, and suggest topics

Additional Recommendations:

  • Review surgical nutrition videos for comprehensive understanding of TPN (Total Parental Nutrition)
  • Familiarize with maintenance fluids and electrolyte compositions for various surgical scenarios