9 Fluids and Electrolytes

5% dextrose infusion stimulates insulin release and prevents protein breakdown, providing 150 g glucose per day (525 kcal/day).

During open abdominal operations, normal fluid loss is 0.5–1.0 L/h, with insensible losses being 10 cc/kg/day (30 L/day for a 70 kg person).

Best indicator of adequate volume replacement is urine output, with the goal being at least 0.5 cc/kg/h.

Insensible losses increase with fever, burns, large open wounds, or ventilated patients.

For significant dehydration, replace fluid losses with appropriate solutions based on the source: normal saline for sweat or gastric losses, and lactated Ringer's for pancreatic, biliary, or small bowel losses.

Gastrointestinal fluid secretion ranges from 1–2 L/day for the stomach, 500–1,000 mL/day for the biliary and pancreatic systems, and 500–1,000 mL/day for the duodenum.

Electrolyte losses include sodium, potassium, bicarbonate, and calcium, with various sources and methods for replacement depending on the electrolyte in question.

Kidneys can remove electrolytes such as potassium, calcium, magnesium, phosphate, urea, and creatinine.

Normal body potassium requirement is 0.5–1.0 mEq/kg/day, and normal sodium requirement is 1–2 mEq/kg/day.

Hyperkalemia symptoms include peaked T waves on EKG and arrhythmias, and can be treated with calcium gluconate, insulin, and sodium bicarbonate.

Hypokalemia symptoms include disappearing T waves, muscle cramps, fatigue, and weakness. It may also be due to pseudohyperkalemia.

Hypernatremia symptoms include restlessness, irritability, seizures, and usually result from poor fluid intake.

Hyponatremia symptoms include headaches, nausea, vomiting, seizures, and can be caused by fluid overload, isotonic fluid loss, or pseudohyponatremia.

Hypocalcemia symptoms include perioral tingling and numbness, hyperreflexia, and prolonged QT interval, and may be caused by parathyroidectomy or magnesium deficiency.

Hypomagnesemia symptoms include irritability, confusion, hyperreflexia, seizures, and may be caused by massive diuresis, chronic TPN without magnesium replacement, or ETOH abuse.

Phosphate imbalances can result in various symptoms and may require specific treatment approaches.

Calcium levels can be affected by various factors and can cause significant symptoms.

Electrolyte balance is important to prevent complications and maintain overall health.

5% dextrose infusion stimulates insulin release and prevents protein breakdown, providing 150 g glucose per day (525 kcal/day).

During open abdominal operations, normal fluid loss is 0.5–1.0 L/h, with insensible losses being 10 cc/kg/day (30 L/day for a 70 kg person).

Best indicator of adequate volume replacement is urine output, with the goal being at least 0.5 cc/kg/h.

Insensible losses increase with fever, burns, large open wounds, or ventilated patients.

For significant dehydration, replace fluid losses with appropriate solutions based on the source: normal saline for sweat or gastric losses, and lactated Ringer's for pancreatic, biliary, or small bowel losses.

Gastrointestinal fluid secretion ranges from 1–2 L/day for the stomach, 500–1,000 mL/day for the biliary and pancreatic systems, and 500–1,000 mL/day for the duodenum.

Electrolyte losses include sodium, potassium, bicarbonate, and calcium, with various sources and methods for replacement depending on the electrolyte in question.

Kidneys can remove electrolytes such as potassium, calcium, magnesium, phosphate, urea, and creatinine.

Normal body potassium requirement is 0.5–1.0 mEq/kg/day, and normal sodium requirement is 1–2 mEq/kg/day.

Hyperkalemia symptoms include peaked T waves on EKG and arrhythmias, and can be treated with calcium gluconate, insulin, and sodium bicarbonate.

Hypokalemia symptoms include disappearing T waves, muscle cramps, fatigue, and weakness. It may also be due to pseudohyperkalemia.

Hypernatremia symptoms include restlessness, irritability, seizures, and usually result from poor fluid intake.

Hyponatremia symptoms include headaches, nausea, vomiting, seizures, and can be caused by fluid overload, isotonic fluid loss, or pseudohyponatremia.

Hypocalcemia symptoms include perioral tingling and numbness, hyperreflexia, and prolonged QT interval, and may be caused by parathyroidectomy or magnesium deficiency.

Hypomagnesemia symptoms include irritability, confusion, hyperreflexia, seizures, and may be caused by massive diuresis, chronic TPN without magnesium replacement, or ETOH abuse.

Phosphate imbalances can result in various symptoms and may require specific treatment approaches.

Calcium levels can be affected by various factors and can cause significant symptoms.

Electrolyte balance is important to prevent complications and maintain overall health.