Wednesday August 30, 2006
FLUID FACTS

When patients return from the OR, you can get fairly good estimate of the fluid replacement in OR and assess further requirements in the ICU. Evaluate if the patient was under hydrated or over hydrated and make adjustments in fluid rates.

1. NPO Deficit:
NPO deficit = number of hours NPO x maintenance fluid requirement

2. Maintenance Fluid Requirements:
Adults: approximately 1.5 ml/kg/hr

3. Replacing Third Space Fluid Losses:

• Superficial surgical trauma: 1-2 ml/kg/hr
• Minimal Surgical Trauma: 3-4 ml/kg/hr (head and neck, hernia, knee surgery)
• Moderate Surgical Trauma: 5-6 ml/kg/hr (hysterectomy, chest surgery)
• Severe surgical trauma: 8-10 ml/kg/hr (or more) (AAA repair, nehprectomy)
  

4. Blood Loss:

• Replace 3 cc of crystalloid solution per cc of blood loss (crystalloid solutions leave the intravascular space).
• When using blood products or colloids replace blood loss volume per volume.
  

Example

62 y/o male, 80 kg, for hemicolectomy
•NPO after 2200, surgery at 0800
•3 hr. procedure, 500 cc blood loss
•What are his estimated intraoperative fluid requirements?

1. Fluid deficit: 1.5 ml/kg/hr x 10 hrs = 1200 ml = 1200 ml total deficit: (Replace 1/2 first hr, 1/4 2nd hr, 1/4 3rd hour).
2. Maintenance: 1.5 ml/kg/hr x 3hrs = 360 ml
3. Third Space Losses: 6 ml/kg/hr x 3 hrs =1440 ml
4. Blood Loss: 500ml x 3 = 1500ml

Total = 1200+360+1440+1500=4500ml