...the exact fluid calculation (Q.4 below) might differ from surgeon to surgeon but the basic reasoning behind the calculation is given below.
P.S. Glucose is added to reduce proteolysis and to prevent muscle breakdown.
Gastric aspirate (to decompress abdomen via nasogastric tube) contains = Na 70, K 5-15, Cl 120, HCO3 0 mmol/L.
N/2 + 20 mmol KCl per litre provides = Na 77, K 20, Cl 77, HCO3 0 mmol/L.
The gastric aspirate and the N/2 formulation with Kcl are similar in composition for replacement.
Patient has developed fever (101 degree F) due to infection. Insensible fluid loss will be more. The dermal loss which can amount to 500-1000 ml per day due to sweating is of greater importance than the respiratory extra loss of about 110 ml per day.
Peritoneal drain loss is 900 ml. Drain is removed when loss becomes approximately <25 ml per day.
Since the previous day intake was 3100 ml and the urine output 800 ml, peritoneal drain loss 900 ml and gastric aspirate loss 600 ml, the obvious intake/output = 3100/2300. Therefore, there was about 800 ml allowance for the insensible loss through skin and respiratory tract.
Generally, maintenance fluid for a patient weighing 60 kg is = 1500 ml + 60 kg x 20 ml = 2700 ml.
Moreover, the patient needs 500-1000 ml fluid more because of the increased insensible loss due to fever.
Urine output is usually 0.5 ml/kg/hr. Therefore, this 60 kg patient can have urine output = 60 x 0.5 x 24 = 720 ml at least. His urine output is 800 ml, which is just enough to wash out the waste products of metabolism in the urine.
The serum electrolytes are normal even after 4 day after the operation. It implies that fluid and electrolyte replacements have been adequate.
Adding about 500 ml more fluid to account for the increased insensible loss due to fever to the previous day intake of 3100 assuming that the gastric aspirate (900 ml) and peritoneal drain (600 ml) losses were similar on the previous day till the present postoperative 4th day.
Therefore, total fluid for the next 24 hours can be 3100 + 500 = 3600 ml.
In order to provide calorie and to reduce proteolysis and to prevent muscle breakdown, 5% Dextrose can be added to provide about 200 kcal. Each gram of glucose provides 4 kcal energy. 5% Dextrose contains 50 mg/ml. Therefore, 1 litre of 5% Dextrose contains 1000 x 50 = 50,000 mg = 50 gram. Energy provided by 50 gram = 50 x 4 = 200 kcal.
Daily infusion of 50 g of glucose increases fat oxidation and suppresses ketogenesis. In case of excessive glucose administration excessive carbon dioxide production will occur, resulting in adverse effects in patients with suboptimal pulmonary function.
The remaining fluid 3600 ml minus 1000 ml 5% Dextrose = 2600 ml can be half normal saline (N/2) or half of each N/2 and Ringer's Lactate solution.
A dose of 20 mmol Kcl in 1 litre can be added to compensate for the loss in gastric aspirate (900 ml).
Since, the total fluid to be given in 24 hours is about 3600 ml, it can be given at an hourly dose of 3600/24= 150 ml/hour.
Generally, most of the post surgical patients need fluid @ 100 ml/hour consisting of 500 ml of 5% Dextrose, 1000ml of Normal Saline and 1000 ml of Ringer's Lactate. Usually, Kcl addition is avoided unless required due to the losses because if Kcl containing fluid is run fast, it can cause arrhythmia and stop the heart.
Maintenance Fluid Calculator:
https://www.ebmconsult.com/app/medical-calculators/maintenance-fluid-calculator
How to calculate IV flow rates:
http://www.unc.edu/~bangel/quiz/testivh.htm
Calculation of Maintenance Fluids;
https://quizlet.com/3740739/calculation-of-maintenance-fluids-medwiki-and-surgical-recall-flash-cards/
GASTRIC ASPIRATE REPLACEMENT:
https://www.seslhd.health.nsw.gov.au/rhw/Newborn_Care/Guidelines/Medical/nccgastricfeb2015.pdf
Insensible water loss from the respiratory tract in patients with fever:
https://www.ncbi.nlm.nih.gov/m/pubmed/7331652/
"Dextrose is pure crystalline glucose. They are not exactly the same ingredient, and probably not interchangeable in fussy recipes. Dextrose is one of the two stereoisomers of glucose, also known as D-glucose. The other is L-glucose."
Is Dextrose same as glucose?
https://cooking.stackexchange.com/questions/41646/is-dextrose-the-same-as-atomized-glucose-powder
Achieving maximum positive nitrogen balance of 4 g/day results in protein synthesis of approximately 25 g/day and body mass gain of 100 g/day.
The late anabolic phase is the final phase of the recovery period, and is characterized by gradual restoration of body protein and fat stores and normalization of positive nitrogen balance after the metabolic response to trauma is stopped. It may take a few weeks to several months after serious injury.
Response to trauma and metabolic changes: posttraumatic metabolism:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379844/
P.S. Glucose is added to reduce proteolysis and to prevent muscle breakdown.
Gastric aspirate (to decompress abdomen via nasogastric tube) contains = Na 70, K 5-15, Cl 120, HCO3 0 mmol/L.
N/2 + 20 mmol KCl per litre provides = Na 77, K 20, Cl 77, HCO3 0 mmol/L.
The gastric aspirate and the N/2 formulation with Kcl are similar in composition for replacement.
Patient has developed fever (101 degree F) due to infection. Insensible fluid loss will be more. The dermal loss which can amount to 500-1000 ml per day due to sweating is of greater importance than the respiratory extra loss of about 110 ml per day.
Peritoneal drain loss is 900 ml. Drain is removed when loss becomes approximately <25 ml per day.
Since the previous day intake was 3100 ml and the urine output 800 ml, peritoneal drain loss 900 ml and gastric aspirate loss 600 ml, the obvious intake/output = 3100/2300. Therefore, there was about 800 ml allowance for the insensible loss through skin and respiratory tract.
Generally, maintenance fluid for a patient weighing 60 kg is = 1500 ml + 60 kg x 20 ml = 2700 ml.
Moreover, the patient needs 500-1000 ml fluid more because of the increased insensible loss due to fever.
Urine output is usually 0.5 ml/kg/hr. Therefore, this 60 kg patient can have urine output = 60 x 0.5 x 24 = 720 ml at least. His urine output is 800 ml, which is just enough to wash out the waste products of metabolism in the urine.
The serum electrolytes are normal even after 4 day after the operation. It implies that fluid and electrolyte replacements have been adequate.
Adding about 500 ml more fluid to account for the increased insensible loss due to fever to the previous day intake of 3100 assuming that the gastric aspirate (900 ml) and peritoneal drain (600 ml) losses were similar on the previous day till the present postoperative 4th day.
Therefore, total fluid for the next 24 hours can be 3100 + 500 = 3600 ml.
In order to provide calorie and to reduce proteolysis and to prevent muscle breakdown, 5% Dextrose can be added to provide about 200 kcal. Each gram of glucose provides 4 kcal energy. 5% Dextrose contains 50 mg/ml. Therefore, 1 litre of 5% Dextrose contains 1000 x 50 = 50,000 mg = 50 gram. Energy provided by 50 gram = 50 x 4 = 200 kcal.
Daily infusion of 50 g of glucose increases fat oxidation and suppresses ketogenesis. In case of excessive glucose administration excessive carbon dioxide production will occur, resulting in adverse effects in patients with suboptimal pulmonary function.
The remaining fluid 3600 ml minus 1000 ml 5% Dextrose = 2600 ml can be half normal saline (N/2) or half of each N/2 and Ringer's Lactate solution.
A dose of 20 mmol Kcl in 1 litre can be added to compensate for the loss in gastric aspirate (900 ml).
Since, the total fluid to be given in 24 hours is about 3600 ml, it can be given at an hourly dose of 3600/24= 150 ml/hour.
Generally, most of the post surgical patients need fluid @ 100 ml/hour consisting of 500 ml of 5% Dextrose, 1000ml of Normal Saline and 1000 ml of Ringer's Lactate. Usually, Kcl addition is avoided unless required due to the losses because if Kcl containing fluid is run fast, it can cause arrhythmia and stop the heart.
Maintenance Fluid Calculator:
https://www.ebmconsult.com/app/medical-calculators/maintenance-fluid-calculator
How to calculate IV flow rates:
http://www.unc.edu/~bangel/quiz/testivh.htm
Calculation of Maintenance Fluids;
https://quizlet.com/3740739/calculation-of-maintenance-fluids-medwiki-and-surgical-recall-flash-cards/
GASTRIC ASPIRATE REPLACEMENT:
https://www.seslhd.health.nsw.gov.au/rhw/Newborn_Care/Guidelines/Medical/nccgastricfeb2015.pdf
Insensible water loss from the respiratory tract in patients with fever:
https://www.ncbi.nlm.nih.gov/m/pubmed/7331652/
"Dextrose is pure crystalline glucose. They are not exactly the same ingredient, and probably not interchangeable in fussy recipes. Dextrose is one of the two stereoisomers of glucose, also known as D-glucose. The other is L-glucose."
Is Dextrose same as glucose?
https://cooking.stackexchange.com/questions/41646/is-dextrose-the-same-as-atomized-glucose-powder
Achieving maximum positive nitrogen balance of 4 g/day results in protein synthesis of approximately 25 g/day and body mass gain of 100 g/day.
The late anabolic phase is the final phase of the recovery period, and is characterized by gradual restoration of body protein and fat stores and normalization of positive nitrogen balance after the metabolic response to trauma is stopped. It may take a few weeks to several months after serious injury.
Response to trauma and metabolic changes: posttraumatic metabolism:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379844/
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