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Fluid Electrolyte Acid baseManagement GeneralsurgerydepartmentThefirstaffiliatedhospitaltoSoochowUniversity overview compositionsofbodyfluid regulationsoffluidbalance acid basebalance importanceoffluidbalance Contentsofdiscuss fluid electrolyte acid basemanagement catalog adjustoffluidmetabolism demonstratecharts basicprinciplesoftreatments Normalbodyfluid osmoticpressureandelectrolytearethebasisofbodymetabolismandorganfunctions Trauma operationandmanyclinicaldisordersleadtofluid electrolyteandacid baseimbalance managementoftheseproblemsisaveryimportantmatterinthesurgicaltherapy 1 fluid electrolyte acid basemanagement overview Maincomponentsofthebodyfluidarewaterandelectrolytes Bodyfluidisdividedintointracellularfluidandextracellularfluid Musclecontainsmuchwater 75 80 Fatcontainslesswater 10 30 fluid electrolyte acid basemanagement compositionsofbodyfluid About60 ofweightofadultmaleisbodyfluid about55 ofweightofadultfemaleisbodyfluid about80 ofweightofinfantisbodyfluid after14yearsold childrenareneartomanhood fluid electrolyte acid basemanagement compositionsofbodyfluid Mostintracellularfluidisinskeletalmuscle intracellularfluidaccount40 ofbodyweightformale forfemaleis35 Extracellularfluidaccount20 ofbodyweightforbothofmaleandfemale Extracellularfluidisfurtherdividedintoplasmaandinterstitialfluid plasmaoccupy5 ofbodyweight Interstitialfluidoccupy15 ofbodyweight fluid electrolyte acid basemanagement compositionsofbodyfluid Mostofinterstitialfluidcanexchangewithplasmaorintracellularfluidquickly andgettobalance whichisveryimportantinfluidandelectrolytemanagement calledfunctionalextracellularfluid fluid electrolyte acid basemanagement compositionsofbodyfluid Otherinterstitialfluidcanonlyexchangeandgettobalanceslowly theyhavedifferentfunctions buttheyarelessimportantinthemaintainofbodyfluidbalance callednonfunctionalextracelluarfluid Connectivetissuefluidandpenetrablefluidofcell e g cerebrospinalfluid synovialfluidanddigestivejuice andsoon areallcallednonfunctionalextracelluarfluid fluid electrolyte acid basemanagement compositionsofbodyfluid Thechangesofsomenonfunctionalextracelluarfluidcanleadtoimbalanceofbodyfluid electrolyteandacid baseobviously Themostfamiliarexampleisagreatdeallossofdigestivejuice itcanleadtomarkedchangeofbodyfluidvolumeandelements 2Nonfunctionalextracelluarfluidoccupies1 2 ofbodyweight andabout10 ofinterstitialfluid fluid electrolyte acid basemanagement compositionsofbodyfluid ThemostimportantcationinextracelluarfluidisNa andthemainanionareCl HCO3 andprotein ThemaincationinintracelluarfluidareK andMg2 themainanionareHPO42 andprotein Theosmolalityofextracelluarfluidandintracelluarfluidareequal theosmolalityofplasmais290 310mmol L fluid electrolyte acid basemanagement compositionsofbodyfluid Thestabilityofbodyfluidandosmoticpressureisadjustedbynerve incretionsystem Thenormalosmoticpressureofbodyfluidisresumedandmaintainedbythalamo posthypophysis antidiureticsystem Thevolumeofbloodisresumedandmaintainedbyrenin aldosteronesystem fluid electrolyte acid basemanagement fluidbalanceandosmoticpressureadjust extracellularosmoticpressure thalamo posthypophysis antidiureticsystem antidiuretichormoneisverysensitivetothechangesofextracellularosmoticpressure evenoverstep 2 extra cellularosmoticpressurefalltonormal waterlose thirst drinkmore waterresorburinereduce waterisreserved keephomeostasis fluid electrolyte acid basemanagement fluidbalanceandosmoticpressureadjust stimulaterenin adrenalaldosterone withincreasedresorptionofnatrium morewaterisresorb extra cellularosmoticpressurefalltonormal bloodvolume bloodpressure Na resorb K drainage H drainage keephomeostasis fluid electrolyte acid basemanagement fluidbalanceandosmoticpressureadjust Bothofthetwosystemsallactonkidneytoadjusttheabsorptionanddrainageofelectrolyteaswaterandnatriumandsoon togetthebodyfluidbalanceandinternalenvironmentstability Thebloodvolumeismoreimportantthanosmoticpressureforbody fluid electrolyte acid basemanagement fluidbalanceandosmoticpressureadjust Soasthebloodvolumereducedgreatlyandinthesametimetheplasmaosmoticpressurereduced theaccelerationforantidiuretichormonebyformerplayamuchmoreimportantrolethanthedepressionforthehormonebylatter 3Thepurposeisatfirsttokeepandresumebloodvolume ensuretheenoughbloodforvitals maintainthesafeofpatients life fluid electrolyte acid basemanagement fluidbalanceandosmoticpressureadjust Thenormalphysiologicalandmetabolismfunctionneednormalbodyfluidwithproperhydrogen UsuallythebodyfluidmaintainacertainconcentrationofH alsomaintainacertainpH arterialplasma spHbetween7 40 0 05 Butintheprocessofmetabolism bodypersistentlyproduceacidandalkalisubstance inthisway theconcentrationofH alsochangesregularly fluid electrolyte acid basemanagement managementofacid basebalance InordertokeepthefluctuationofconcentrationofH inasmallrange thebodyadjusttheacidandalklaibybuffersystem breathingwithlungandexcretionwithkidney ThemostimportantbuffersysteminbloodisHCO3 H2CO3 fluid electrolyte acid basemanagement managementofacid basebalance ThenormalmeanvalueofHCO3 is24mmol L H2CO3is1 2mmol L theratioofHCO3 H2CO3 24 1 2 20 1 nomatterhowhigherorlowertheHCO3 andH2CO3are theratioofHCO3 H2CO3stillkeepsin20 1 pHofplasmaisremaining7 40 4e g H HCO3 H2CO3 H2O CO2 fluid electrolyte acid basemanagement managementofacid basebalance Breathoflungadjusttheacid basebalancebydischargingCO2fromlung thiscanreducePaCO2inblood inthesametime alsoadjustH2CO3inblood Ifrespiratoryisinsufficiency itwillleadacid basedisorder anditwillalsodepressitscompensatorycapacityofacid basebalance fluid electrolyte acid basemanagement managementofacid basebalance Kidneyplaythemostimpotantmanangementroleintheacid basebalancesystem kidneymaintainnormalconcentrationofHCO3 inplasmabychangingoutputoffixedacidandalkalitokeeppHofplasmainnormalrange Ifkidneyisabnormal itnotonlyeffectthenormaladjustofacid basebalance butalsoleadacid baseimbalance fluid electrolyte acid basemanagement managementofacid basebalance Intheclinicalwork wemaymeetmanyproblemsaboutwater electrolyteandacid basebalancewithdifferentcharactersanddegrees Manysuddenandserioussicknessesoftheinternalmedicineandsurgery e g shock massivehemorrhageofdigestivetract largeareaburns digestivetractfistula intestinalobstructionandseriousperitonitis allthesecanleadbadlyinternalenvironmentdisordersfordehydration hypovolemia hypokalemiaandacidosis fluid electrolyte acid basemanagement importance Recognizingintimeandactivelycorrectingtheseabnormalitiesisthefirstjobinourtherapies becausetheaggravationforeachofwater electrolyteandacid baseimbalancewillleadthepatients death Whenthethepatientswithelectrolytedisorderoracidosis thedangerforoperationwillincreaseobviously 5Eventheoperationissuccessful Ifweignorethemaintenanceofinternalenvironment itwillresulttothefailureoftherapyatlast fluid electrolyte acid basemanagement importance Therearemanydifferentclinicalmanifestationsofbodyfluid electrolyteandacid baseimbalance Thereareusuallymixedabnormalitiesinthesametime notonlybodyfluidandelectrolytedisorder butalsoacid baseimbalance Soweshouldcorrectthemoverall anddonnotmissanyone fluid electrolyte acid basemanagement importance VolumeDisorders isotonicbodyfluiddecreaseorincrease Itonlycausesextracellularfluidvaried andintracellularfluidisusuallynormal fluid electrolyte acid basemanagement maladjustmentoffluidmetabolism ConcentrationDisorders thewaterofextracellularfluiddecreaseorincrease itleadingthechangesofconcentrationofinfiltrationparticulates sotheosmoticpressurealsochanges Because90 infiltratingparticulatesofextracellularfluidareconstitutedbyNa sothattheconcentrationdisordersdisplayashyponatremiaorhypernatremia fluid electrolyte acid basemanagement maladjustmentoffluidmetabolism CompositionsDisorders thechangeofconcentrationofotherionsinextracellularfluid exceptNa Althoughtheseionscancausesomephysio pathologicaleffect theamountofpenetrableparticulatesaresolittle theironlyhaveslightinfluencetoextracelluarfluid Forexample hypopotassaemiaorhyperpotassaemia hypocalcemiaorhypercalcemia andacidosisoralkalosis andsoon fluid electrolyte acid basemanagement maladjustmentoffluidmetabolism hypertonicdehydration bodyfluiddecrease intracellularfluidwaterloss saltloss osmoticpressure thirst extracellularfluid intracellularfluidMove intracellular intoextracellularfluidfluid sweatglandsecrete osmoticpressure skinevaporation seriouscerebrocellular dehydration centralnervoussystemADHsecret coma fluid electrolyte acid basemanagement changesandeffectofhypertonicdehydration ADHsecret extracellularfluid dehydrationslightly BP slightly changelittle renaltubulereabsorb waterandnatrium ALDexcretenormal hypourocriniaearlyperiodUNanotdecrease fluid electrolyte acid basemanagement changesandeffectofhypertonicdehydration fluid electrolyte acid basemanagement changesandeffectofhypotonicdehydration hypotonicdehydration bodyfluiddecrease saltloss waterloss interstitial eyeholeintrocession fluid Skinelasticity ECFosmotic ECFintocell ECFdecreasepressure pachemia bloodvolume veincollapse decrease BPdecreaseADHsecrete Severityshock ICFdecrease notobviouslyALDsecrete renaltubulereabsorbrenaltubulereabsorbwaterandnatrum waterandnatrum earlierperiodurinaryUNadecreaseorabolitionvolumenotdecrease fluid electrolyte acid basemanagement comparison fluid electrolyte acid basemanagement comparison fluid electrolyte acid basemanagement causeandeffectofhypokalemia fluid electrolyte acid basemanagement causeandeffectofhyperkalemia fluid electrolyte acid basemanagement ECGofhypokalemiaandhyperkalemia NormalECGPwaveQRSintervalTwaveQTintervalS Tstage fluid electrolyte acid basemanagement ECGofhypokalemiaandhyperkalemia ECGofHypokalemiaS TlowerQTprolongUwave fluid electrolyte acid basemanagement ECGofhypokalemiaandhyperkalemia ECGofHyperkalemiaQRSprolongTwave QTprolong fluid electrolyte acid basemanagement examinationofacid baseimbalance ArterialbloodgasanalysisPH 7 35 7 45actualbicarbonate AB standbicarbonate SB AB SB 21 27mmol LnormalAB SBrespiratoryacidosisAB SBrespiratoryalkalosisAB SB metabolicacidosisAB SB metabolicalkalosisbufferbase BB includeHCO3 45 55mmol Lbufferexcess BE 3 3mmol LPCO2 4 67 6 0kPa 35 45mmHg PO2 8 0kPa 60mmHg fluid electrolyte acid basemanagement causeandeffectofmetabolicacidosis fluid electrolyte acid basemanagement causeandeffectofmetabolicalkalosis fluid electrolyte acid basemanagement comparisonofacid baseimbalance bodyfluid electrolyteandacid baseimbalanceisaverycommonpathophysiologicchangeclinically nomatterwhichkindofimbalance itcanleaddisordersofmetabolism ifitfurtheraggravate willcauseorganfailure evendeath followsarethebasicprinciplesofmanagementforbodyfluid electrolyteandacid baseimbalance fluid electrolyte acid basemanagement basicprinciplesofclinicaltherapy Mastermedicalhistorythoroughly andexaminethepatients signssufficiently inmostcondition wecangetvalueableinformationandmakeoutinitialdiagnosis Findoutcauseswhichmayleadbodyfluidimbalance e g severevomit diarrhea intakelessforlongtime severeinfectionorsepticemia Findoutthesymptomsorsignsofbodyfluidimbalance e g dehydration hypourocrinia tachypnea insanity andsoon fluid electrolyte acid basemanagement basicprinciplesofclinicaltherapy 1 bloodandurineroutine hematocrit liver renalfunction bloodglucose 2 bloodserumK Na CI Ca2 Mg2 andPi 3 arterialbloodgasanalysis 4 determinbloodurineosmoticpressure p r n Laboratoryexamination fluid electrolyte acid basemanagement basicprinciplesofclinicaltherapy Comprehendingthecasehistoryandabove mentionedlaboratorydata wecandeterminethetypeanddegreeofwater electrolytesandacid basedisorders Weshould