Balance Hidroelectrolítico

Internado de CirugíaInterno: Mervin Piñones A.

Homeostasis

Balance Hidroelectrolítico

INGRESOS EGRESOS=

EGRESOS• PERDIDAS INSENSIBLES • PERDIDAS SENSIBLES

EVAPORACIÓN: PIEL TRACTO RESPIRATORIO

Diuresis Deposiciones Diaforesis

CALCULAR MEDIR

PERDIDAS SENSIBLES

Diuresis 0,5cc/kg/h – 4cc/Kg/h

Deposiciones 40ml cada 1000Kcal ingeridas

PERDIDAS INSENSIBLES

PIEL 7cc/kg/día

RESPIRATORIA 5cc/Kg/día

12cc/Kg/d0,5cc/Kg/h

400cc/m2/d

ADULTO NIÑOS

SUPERFICIE CORPORAL

Mosteller SC = [( cm x Kg ) / 3600] 1/2

         SC = [(4 x Kg ) + 7] / (90 + Kg )                          

( 0.425 ) ( 0.725 ) Peso X Talla X 0..007184SC=

Condiciones Anormales

• Taquipnea 1ml/h por cada respiracion sobre 20/min

• Diaforesis LEVE ……………… 8 ml / Kg /día MODERADO ……. 15 ml / Kg /día SEVERO …………. 30 ml / Kg / día

• FIEBRE Por cada 1ºC sostenido sobre 37°:

– 6ml/h– 5 ml /Kg /día

• CIRUGIA: 5 ml / Kg / hora / hora operatoria400-600 cx menores o 800-900cc en cx mayores

COMPOSICION DE SECRECIONES GASTROINTESTINALES

Secrecion Vol. ml/24 h Na+ mmol/L K+ mmol/L Cl- mmol/L HCO3-mmol/L

Saliva 1500 10 26 10 30

Gastrico 1500 65 10 100

Duodeno 90 15 90 15

Pancreas 100-800 150 7 80 75

Bilis 400-800 150 4 100 35

Intestino delgado

140 6 100 20

Ileon terminal

3000 140 8 60 70

Colon 40 90 17 30

Ingresos Egresos

Via oral Diuresis

Sueros Deposiciones

Régimen Vómitos

OTROS: fiebre, dren, etc.

TOTAL TOTAL

BH

1cc /Kcal

Composición (mEq/L) Solución Volumen(es) (mL) Sodio Cloro Calcio pH Tonicidad mOsm/L Albúmina 5% 250, 500 145 145 0 6.9 Isotónico ~ 300 Albúmina 25 % 20, 50, 100 145 145 0 6.9 Hipertónico ? Hetastarch 6 % 500 154 154 0 5.5 Isotónico 310 Pentastarch 10% 500 154 154 0 5.0 Isotónico 326 Gelatinas 500 154 125 0 7.4 Isotónico 279 Poligelinas 500 145 145 12 7.3 Isotónico 370 Oxipoligelatinas 250, 500 154 130 1 7.0 Isotónico 300

Coloides

• Hypovolaemia due predominantly to blood loss should be treated with either a balanced crystalloid solution or a suitable colloid until packed red cells are available.

• Hypovolaemia due to severe inflammation such as infection, peritonitis, pancreatitis or burns should be treated with either a suitable colloid or a balanced crystalloid.

• In either clinical scenario, care must be taken to administer sufficient balanced crystalloid and colloid to normalise haemodynamic parameters and minimise overload.

• When the diagnosis of hypovolaemia is in doubt and the central venous pressure is not raised, the response to a bolus infusion of 200 ml of a suitable colloid or crystalloid should be tested.

• The response should be assessed using the patient’s cardiac output and stroke volume measured by flow-based technology if available. Alternatively, the clinical response may be monitored by measurement/estimation of the pulse, capillary refill, CVP and blood pressure before and 15 minutes after receiving the infusion.

• To meet maintenance requirements, patients should receive sodium 50-100 mmol/day, potassium 40-80 mmol/day in 1.5-2.5 litres of water by the oral, enteral or parenteral route (or a combination of routes). Additional amounts should be given to correct deficit or continuing losses. Careful monitoring should be undertaken using clinical examination, fluid balance charts and regular weighing, when possible

• Produced by the Fluid Prescription Working Group.

• 2nd edition November 2012.

Electrolyte requirements• Sodium 1 mmol/kg/24hrs (approx. 1x500ml

0.9%NaCl) • Potassium 1 mmol/kg/24hrs (give KCl

20mmol in each bag)• Calories: minimum of 400kcal/24hrs to help

with electrolyte handling and to help avoid insulin resistance.

• Preferred maintenance fluids: 0.18%saline/4%dextrose with or without added potassium (KCl 10/ 20 mmol) in 500ml.

• Alternatively 5% dextrose 500ml and 0.9% NaCl 500ml may be used in a ratio of 2 bags of 5% dextrose to 1 bag of 0.9% NaCl. Prescribe each bag with added potassium (KCl 20mmol) if patient has normal or low potassium.

Cloruro de Potasio

Composición: • Inyectable 10%: cada ampolla de 10 ml y

frasco-ampolla de 50 ml contienen: Potasio Cloruro 10%.

• Inyectable 20%: cada ampolla de 5 ml contiene: Potasio Cloruro 20%.

1g = 10ml 10% o 5ml 20%

Cloruro de sodio

• Composición: Inyectable 0.9%: cada ampolla inyectable de 5, 10 ó 20 ml de suero fisiológico contiene: Cloruro de Sodio (0.9%) 45, 90 ó 180 mg.

• Inyectable 10%: cada ampolla inyectable de 10 ó 20 ml contiene: Cloruro de Sodio (10%) 1 ó 2 g.

• Inyectable 11.7%: cada ampolla contiene: Cloruro de Sodio (11.7%) 1.17 ó 2.34 g.

• Inyectable 20%: cada ampolla inyectable de 5, 10 y 20 ml contiene: Cloruro de Sodio (20%) 1, 2, 4 gramos.