Fluid 2021
Fluid 2021
Fluid 2021
BLOOD TRANSFUSION
6 months 70
1 year 60
Young adult 60
Elderly Lowest 50
Age and TBW inversely correlated to each other
Composition of Body Fluid Compartments
Intravascular
• Range 275-299
Tonicity
• A way of describing the relative solute
concentrations of two solutions which are
separated by a selectively-permeable
membrane (often called a semi-permeable
membrane).
Inside Outside
movement movement
WHAT IS THE ‘NORMAL’
DAILY INTAKE AND
OUTPUT OF FLUID AND
ELECTROLYTES?
OUTPUT, INTAKE
Normally should the output =input
• Ex. 70 kg patient
For patient
Above 20kg
1st 10 kg: 10 kg * 4 ml = 40 ml / hr
You can also
Calculate
2nd 10 kg: 10 kg * 2 ml = 20 ml / hr
maintenance
Using
3rd 10 kg: 50 kg * 1 ml = 50 ml / hr
=Kg+ 40ml/ hr
Total=110ml/hr
De cit calculation
• Ex. Fasting for 10 hr without any intake: 10*110=
INTRAOPERATIVE
FLUID LOSS
1 ml blood loss give 3 ml crystalloid( normal saline)
1:3
1:1 1 ml blood loss give 1 ml colloid(blood product)
Factors determine which one give ?
1) baseline Hb
2)hemodynamic stability
3)high risk patients
4)surgery time
5) availability of blood
6)bleeding tendency
Allowable Blood Loss (ABL)
Amount of blood that can lost without need to compensated
• Women 37-47%
ALLOWABLE BLOOD
LOSS
Hb 7 mg/dl ??????
Availability of test and blood
ALLOWABLE BLOOD
LOSS
Pediatric
Adult
20% of total blood in the body (adults)
10-15% of total blood in the body (pediatrics)
Estimated Blood Volume (EBV)
• Men 75 ml / kg
• Women 65 ml / kg
• Infants 80 ml / kg
• Neonates 85 ml / kg
• Premature Neonates 95 ml / kg
INTRAVENOUS FLUIDS
Types
• types
• 9 g of NaCl/L water
• 154 mmol/L sodium
• 154 mmol/L chloride
• Osmolality = 308 mosm/L Hypertonic but consider isotonic
• PH = 5.0
• Potential problem = hyperchloraemic metabolic
acidosis, more likely with renal insufficiency
Special Solutions
• Hypertonic (3%) saline....
Ph
hyponatremia
Osmo
• 30 gm NaCl, 1027, 4.5 to 7.0
• Platelets
• Cryprecipitate
• Human albumin
• PRBCS(hematocrit 70%):
• 250 mL+saline preservative=350 mL.
• 1–6°C.
• May be frozen in a hypertonic glycerol solution for up to
10 years(rare phenotypes)
• Platelet:
• 50–70 mL.
• 20–24°C for 5 days.
• Plasma:
• The remaining plasma supernatant is further processed and
frozen to yield fresh frozen plasma; rapid freezing helps prevent
inactivation of labile coagulation factors (V and VIII). Slow
thawing of fresh frozen plasma yields a gelatinous precipitate
(cryoprecipitate) that contains high concentrations of Factor VIII
and fibrinogen.
• 200 mL.
• Once thawed it must be transfused within 24 h.
BUT BEFORE
EVERYTHING THE BLOOD
BANK HAS TESTS TO
COMPARE THE BLOOD OF
THE DONOR TO THE
BLOOD OF THE RECIPIENT
So you must know the blood groups
Blood Groups
A Anti-B 45%
B Anti-A 8%
AB (Universal — 4%
recipient)
CELL SAVER
Never used in cancer patients
CELL SAVER
LEVEL 1 (A) INFUSION
PUMP
• Infectious complications
TRALI
• ARDS following blood transfusion
Accumulation of uid in the alveoli