Fluid issues

[juddson]

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I need a bit if help on this:

Let's assume a 70kg male who's NPO after midnight for endoscopy sometime the following morning. He's not sick and endoscopy is associated with fluid or lyte losses, so we can deal only with the "maintenance" aspect of fluid therapy. Let's also assume he's NPO for 24 hours because (for whatever reason) he can't take oral for a while after his procedure.

Now, as I understand it his fluid losses over 24 hours due to urine, feces, sweat, lungs are about 2L (30ml/kg). My surgery text says that if I'm going to use IV only (which I would), he needs only 2L of D5 (ie., no lytes) because the kidneys reabsorb everything if they are working properly.

On the other hand, a lecture I have says he'll lose about 75-150mEq of Na and Cl and 40 mEq of K per day, which would seem to suggest that he actually will need 2L of D5 1/2 normal saline + 40KCL on the high side or 2L D5 1/4 normal saline on the low side.

What gives? Who has a quick and dirty way to handle fluids and lytes?

Judd

 

[jdh71]

it really speaks more to a difference in philosophy. the important thing to get your mind around is that outside of certain situations (ICU, burns, exsanguination) it is not so important to make sure every mEq is replaced perfectly especially if the kidneys are working fine. For most inpatient NPO situations D5 1/2 with 20 mEq of K run at a maintenence rate is all you need.

 

[Dr JPH]

Agree with above.

For non trauma situations you cant go wrong with running D5 1/2 NSS @ an appropriate maintenance rate.

If you are concerned about electrolyte imbalance adding mag, phos or K is easy. And you can always bump up to NSS if need be.

Patients with free water deficit are a whole different story.

I would put the guy on D5 1/2 NSS @ 125/hr. If he has CHF or I am worried about fluid overload then I may adjust.