Standard fluid regime for NBM patients:
- N/2 * 2 bags
- 4 % dextrose + N/5 + 30mmol KCl
In terms of fluid requirements,
- 65% of body is water (TBW)
- 2/3 of this is intracellular, 1/3 extracellular
Ways you can lose electrolytes:
- Vomiting → loss of K
- Diarrhoea→ loss of K
- Sweat→ loss of NaCl
- Burns → loss of protein and Na
- Third space losses → loss of NaCl + H20
Ways to assess dehydration:
- Urine dipstick - concentration
- ↑ Ur and ↑ Na
Correction of hypernatremia begins with a calculation of the fluid deficit. Predicted insensible and other ongoing losses are added to this number and the total is administered over 48 hours. Recheck serum electrolyte levels frequently during therapy. To avoid cerebral edema and associated complications, the serum sodium level should be raised by no more than 1 mEq/L every hour. In patients with chronic hypernatremia, an even more gradual rate is preferred.Free Water Deficit (L) = Body Weight (kg) X Percentage of Total Body Water (TBW) X ([Serum Na / 140] - 1)
Percentage of TBW should be as follows:
- Young men - 0.6%
- Young women and elderly men - 0.5%
- Elderly women - 0.4%
Example:
- A serum sodium level of 155 in a 60-kg young man represents a fluid deficit of 60 X 0.6 X ([155 / 140] - 1) or 3.9 L
- With another 900 mL of insensible losses, the patient requires 4.8 L of fluid in the next 48 hours, resulting in an infusion rate of 100 mL/h.
SIADH
- Pure water depletion and ↑ Na → use 4% D + N/5 to treat it.
- Stimulating the bowel e.g. abdo surgery → release of ADH → SIADH
References
- http://www.merck.com/mmpe/print/sec12/ch156/ch156e.html
- http://emedicine.medscape.com/article/766683-treatment
