Specific replacement fluids of specific losses

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Specific replacement fluids of specific losses

This section is for reference by the enthusiastic fludologist only. The solutions refered to are not routinely available.

Refer to the contents of gastrointestinal secretions seen in table 2.

Gastric fluid

(nasogastric tube, emesis) Dextrose/Saline with 20 mmol/litre KCl; replace equal volume of lost fluid every 6 hours. You may run into a Cl $\ensuremath{^-}$ deficit with a resistant alkalosis if you dont give some more chloride. However, Saline will give too much Na $\ensuremath{^+}$ unless the acid secretion from the stomach is halted with drugs.

Saline if patient on acid blockers
Solution .18 if patient not on acid blockers

Diarrhoea

Hartman's with 15 mmol/litre KCl. Provide 1 litre replacement for each 1 kg or 2.2 lb of lost body weight; bicarbonate 45 mmol(1/2 amp) per litre may be added

Bile

D5LR with 25 mmol/litre (1/2 amp) of HCO $\ensuremath {_3^-}$ . This is from an american book and this D5LR solution is not used here. Adding HCO $\ensuremath {_3^-}$ to salty solutions will result in precipitation. So a sugary solution with little salt is used. Pancreatic juice has more HCO $\ensuremath {_3^-}$ and less Cl $\ensuremath{^-}$ than bile. You could say ECF solutions (saline or Hartman's) with replacement of HCO $\ensuremath {_3^-}$ on an occasional basis depending on the patients biochemistry.

Pancreatic

D5LR with 50 mmol/litre (1 amp) HCO $\ensuremath {_3^-}$

Next: Normal acid base balance Up: Administration fluid guidelines Previous: Administration fluid guidelines Index

Adrian P. Ireland