Fluids and Electrolytes
Name: GANDINGCO, Ma. Jastin Anne C.
ID No. 19-0944-992
Group: 8B
GROUP 8A
GROUP 8B
Alcoy, Carl Kevin
Agor, Mariella Ann M.
Gacusan, Ranne Cenchreae H.
Dizon, Meryl Angeli P.
Montarde, Micko Angelika A.
Espiritu, Geremiah D.M.
Regudo, Monica Ariane Gail O.
Gandingco, Ma. Jastin Anne C.
Salvador, Alyssa Jade I.
Gomez, Gillian M.
Santos, Princess Mae B.
Shumba, Miranda T.
Case 1: 27/M, 70kg, admitted due to hypotension and delirium following a vehicular accident. BP
is palpatory 60 mmHg, HR 130/min, pulses are weak and thready. He underwent exploratory
laparotomy. After the operation, he was placed on nothing per orem (NPO), and hooked to a
respirator. NGT output was 2000 ml/24 hours.
1. Compute for:
a. Total body water (TBW): 70 kg x 0.60 = 42 L
b. Extracellular fluid (ECF): 70 kg x 0.20 = 14 L
c. Intracellular fluid (ICF): 70 x 0.40 = 28 L
d. Plasma: 70 kg x 0.05 = 3.5L
e. Interstitial fluid volume: 42 x 0.15 = 10.5 L
f. Blood volume: 70 kg x 0.08 = 5.60 L
2. How much blood was lost by the patient based on the clinical manifestations following injury?
Since the patient manifests marked hypotension (BP=60 mmHg), delirium, tachycardia
(HR =120) and weak pulses; we can classify him under Class III based on the ATLS
classification.
Formula: (Blood Volume x 30%) = (5.6 L x 0.30) = 1.68 L
3. How much fluid must be given to him for 24 hours?
Since the patient is having an abnormal loss of fluids via NGT, Replacement therapy
should be done.
Formula: (Weight in kg x 35mL/kg) + ongoing fluid loss
= (70kg x 35mL/kg) + 2000mL/ 24 hours = 4,450mL/day
4. What are the ideal intravenous (IV) fluids to be given?
Because the patient is experiencing abnormal loss of fluids via NGT, IV Normal
saline (0.9% NaCl) and IV Ringer’s Lactate solution can be given. Both solutions are isotonic
salt solutions and are indicated for fluid resuscitation and maintenance fluid therapy. However,
fluid losses from NGT depletes the patient’s Na+, K+ and Cl-, which eventually leads to
Chloride-Responsive Metabolic Alkalosis; hence, normal saline (0.9%) is more suitable IV
replacement for it has more Cl- than Ringers lactate.
5. What are the sources of ongoing losses in this patient?
On-going normal fluid losses result from the body’s use of fluid to facilitate
excretion of waste products. Therefore, the patient is losing fluid from his urine, skin, lungs
and feces. Additionally, the patient is also losing naso-gastric fluid via the inserted NGT. NGT
output was 2000 ml/24 hours.
6. What are the different parameters that can be used to determine adequate hydration?
During physical examination, we can test for the skin turgor, moistness of mucus
membranes, weight, and blood pressure and pulses. To further examine the patient, we can
test for the venous filling and ocular tension. Most importantly, check the urine output to
determine the patient's hydration status.
Case 2: 50/F 70kg, admitted due to continuous vomiting of ingested food. Diagnosis is gastric
outlet obstruction due to pyloric cancer. NGT output is 2500 ml/24 hours.
1. Compute for the following:
a. TBW: 35L(70kgx50%)
b. ECF: 14L(70kgx20%)
c. ICF: 21L(70kgx30%)
2. Compute for the replacement and maintenance therapy
Maintenance Therapy:
70kgx35ml/kg = 2450 L
Replacement Therapy:
= Maintenance therapy + ongoing losses = (70kg x 35ml/kg) x (2500 ml/24hr)
= 4950 ml/day
3. What electrolytes and acid-base imbalances may occur if she continues to vomit?
Prolonged vomiting can generate metabolic alkalosis, a condition where the blood is
overly alkaline (elevated pH). This eventually presents with hypochloremia. Imbalances in
the body such as hypokalemia, gastrointestinal and renal H + loss, excess bicarbonate in the
blood, and aciduria may occur.
4. What is the pathophysiology of the said imbalance?
Metabolic alkalosis results from the loss of fixed acids and increased bicarbonate (HCO3)
generation. Due to vomiting, the loss of gastric fluids will cause H+, Cl-, Na+, and K+ depletion.
The body will compensate by excreting HCO3-, then reabsorption of Na+ through the Renin
Angiotensin Aldosterone System which will produce aldosterone that will retain Na+ and
water, and there will also be excretion of K+ that will lead to hypokalemia. This will lead to a
phenomenon called paradoxical aciduria where the resulting hypokalemia leads to the
excretion of H+.
5. What IV fluids is needed to correct the imbalance?
The patient is experiencing isotonic dehydration due to vomiting brought about by
gastric outlet obstruction which is caused by pyloric cancer. Isotonic salt solution shall be
given to the patient to replenish the volume deficit. If the urine output becomes stable,
hypokalemia can be addressed by giving supplemental potassium.