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Introduction
Perioperative fluid deficit occured as a result of the preoperative fasting
Introduction...contd
Plasma
5% TBW
Interstitial
15% TBW
Intracellular
40% TBW
Capillary membrane
endothel
Blood cell
Cation
Major cation in extracellular fluid is sodium (Na +), while
major cation in intracellular fluid is potassium (K +).
Anion
Major anion in extracellular fluid is chloride (Cl-) and bicarbonate (HCO3-), while the major anions found in
Osmotic Difusion
OSMOSIS
OSMOTIC PRESSURE
EQUILIBRIUM STATE
Change of concentration
Hyponatremia Hypernatremia Hypokalemia Hyperkalemia
Change of composition
Respiratory acidosis (pH< 3,75 and PaCO2> 45 mmHg) Respiratory alcalosis (pH> 7,45 and PaCO2 < 35 mmHg) Metabolic acidosis (pH<7,35 and bicarbonat <21 mEq/L) Metabolic alcalosis (pH>7,45 and bikarbonat >27 mEq/L)
Fluids In Operative
Disturbances in fluid and electrolyte balance are
common in surgical patients due to a combination of preoperative, perioperative and postoperative factors.
Preoperative factors
Pre-existing conditions
Diagnostic procedures
Drug delivery Surgical preparation Medical management of pre-existing
conditions
Perioperative Factors
Induction of anesthesia Abnormal blood loss Abnormal loss of extracellular fluid into the third space
Postoperative factor
Stress of surgery and postoperative pain Increase of tissue catabolism Decrease in effective circulating volume Risk or the presence of postoperative ileus
Pathophysiology
Trauma, surgery and anesthesia will cause changes in
water balance and metabolism.
Pathophysiology...contd
Pathophysiology...contd
approximately 50 ml/kgBB/24 hours. Replacing fluids lost in the post surgical Continuing the fluid deficit replacement The correction of balance disturbance casued by fluid therapy
Kinds of Fluids
Crystalloid Fluids This fluid has a composition similar to extracellular fluid (CES = CEF). Advantages: cheap, easily available at any health center, no need to do a cross match, does not cause allergic or anaphylactic shock, simple storage and can be stored longer. As effective as colloid fluid administration to overcome the deficit in intravascular volume. Half-life of crystalloid fluid in the intravascular space of about 20-30 minutes.
Crystalloids Composition
The Colloids
Colloid Fluids Also referred to as a plasma substitute fluids or commonly called "plasma substitute" or the "plasma expander". The substances have a high molecular weight by osmotic activity that causes this fluid tends to persist for longer time (a half-life 3-6 hours) in the intravascular space. Often used for rapid fluid resuscitation, especially in hypovolemic shock / hermorhagik or in patients with severe hypoalbuminemia and loss of protein which many (eg burns). Disavantages of plasma expander are expensive and can cause anaphylactic reactions (although rare) and can cause interference on the "cross match".
Conclusion
Body fluids is a solution consisting of water (solvent) and certain
substances (solutes).
Conclusion...contd
Conclusion...contd