The daily fluid requirement in an adult. Adult daily water requirement: online calculator. The absolute amount of urine allocated for a certain time must be correlated with the volume of fluid introduced into the body during the same time period.

Principles of Infusion Rehydration Therapy

General rules for drawing up a program of infusion therapy

1. Colloidal solutions contain sodium salts and belong to saline solutions and their volume should be taken into account in the total volume of saline solutions.

2. In total, colloidal solutions should not exceed 1/3 of the total daily volume of fluid for infusion therapy.

3. In young children, the ratio of glucose and salt solutions is 2: 1 or 1: 1; at an older age, the number of saline solutions increases (1: 1 or 1: 2).

3.1. The type of dehydration affects the ratio of glucose-salt solutions in the composition of infusion media.

4. All solutions must be divided into portions (“droppers”), the volume of which for glucose usually does not exceed 10-15 ml / kg and 7-10 ml for colloidal and saline solutions. A container for one drip should not contain more than ¼ calculated daily volume of liquid. It is unrealistic for a child to spend more than 3 drip administrations per day.

With infusion rehydration therapy, 4 stages are distinguished: 1. anti-shock measures (1-3 hours); 2. Compensation of extracellular fluid deficiency (1-2-3 days); 3. maintaining the water-electrolyte balance in the context of ongoing pathological losses (2-4 days or more); parenteral nutrition (full or partial) or therapeutic enteral nutrition.

To maintain the state of homeostasis, it is necessary to ensure a balance between the fluid introduced into the body and the fluid that the body removes in the form of urine, sweat, feces, with exhaled air. The number and nature of the loss varies depending on the nature of the disease.

The amount of fluid needed to compensate for the physiological loss of the body in children of different ages is not the same.

Tab. 1. 69.Age-related need for fluid and electrolytes for children

The physiological need for sodium in young children is 3-5 mmol / kg; in older children, 2-3 mmol / kg;

The need for potassium is 1-3 mmol / kg;

The need for magnesium averages 0.1 mmol / kg.

The need for fluid and electrolytes needed to compensate for physiological losses can be calculated using several methods.

The daily maintenance fluid (fluid requirement) can be calculated in several ways: 1) based on taking into account the surface area of \u200b\u200bthe body (there is a correlation between these indicators); 2) the energy method (there is a relationship between energy needs and body weight). The minimum water requirement is 100-150 ml / 100 kcal; 3) according to Aberdeen's nomogram (or to tables made on its basis - Table 1.69).

In some pathological conditions, the loss of water and / or electrolytes can significantly increase or decrease.

Tab. 1.70.Current pathological losses. Fluid Changing Conditions

condition

Fluid requirement

Fever Hypothermia Vomiting indomitable Diarrhea Heart failure Pulmonary edema Increased sweating Hyperventilation Increased air humidity Renal failure Intestinal paresis Phototherapy High ambient temperature Increased metabolism of mechanical ventilation in newborns (with good moisture)

An increase of 10 ml / kg for every degree of temperature increase A decrease of 10 ml / kg for every degree of temperature decrease Increase in demand by 20-30 ml / kg / day Increase by 25-50 ml / kg / day Decrease in need by 25-50% depending on the degree of insufficiency Decrease in demand up to 20-30 ml / kg / day Increase in demand by 10-25 ml / 100 kcal Increase in demand up to 50-60 ml / 100 kcal Decrease in demand by 0-15 ml / 100 kcal -30 ml / kg / day; Increased demand by 25-50 ml / kg / day; Increased demand by 15-30% An increase in demand by 50-100% An increase in demand by 25-75% A decrease in demand by 20-30 ml / kg from the daily requirement

To cover the need for fluid, it is necessary to take into account the physiological need for fluid (1500-1800 ml / m 2) or calculated according to the tables (table. 1.69), or by the energy method and add to them the fluid loss detected by the patient.

General principles for calculating the necessary fluid:

SJ \u003d SZHP + ZhVO + ZhVTPP,   Where SJ   - calculated daily fluid, SJP   - daily maintenance fluid, LUT   - dehydration compensation fluid, ZhVTPP   - liquid compensation for current pathological losses.

14354 0

The need for water of a healthy or sick body is determined by the total value of its excretion from the body with urine, through the skin, from the surface of the lungs, with feces. For adults, the need for water is 40 ml / kg per day (V. A. Negovsky, A. M. Gurvich, E. S. Zolotokrylina, 1987), the daily need for sodium is 1.5 mmol / kg, in calcium - approximately 9 mmol (10 ml of a 10% solution of gluconate or calcium chloride), and the daily need for magnesium is 0.33 mmol / kg. The amount of 25% magnesium sulfate can be determined by the formula:

Total daily requirement (MgSO4) in mmol: 2 \u003d ml / day.

It is desirable to introduce potassium chloride in a glucose solution with insulin, but its concentration should not exceed 0.75%, and the rate of administration is 0.5 mmol / (kg. Hour). The total potassium load should not exceed 2-3 mmol / (kg day).

The physiological need for fluid is offset by saline solutions and 5-10% glucose solution in a ratio of 1: 2 or 1: 1.

The next step in the implementation of the infusion program is to compensate for the deficiency of fluid and ions and current pathological losses in the patient's body. It should be noted that this problem should be solved in the first place, since it is here that the success of treatment is laid in many respects.

Distinguish between physiological and pathological losses. So, the prospect in adults is 0.5 ml / kg per hour. Losses with diuresis are normal 1 ml / kg per hour.

Knowledge of physiological losses is especially important and necessary when carrying out infusion therapy in patients with renal failure, since the figures given for daily fluid requirements already include physiological losses. Equally important is the consideration of pathological losses, which can reach significant values. So, with hyperthermia (more than 37 °) and an increase in body temperature by 1 °, water loss increases on average by 500 ml per day. The water released with sweat contains 20-25 mosmol / l Na + and 15-35 mosmol / l SG. Losses can increase with fever, thyrotoxic crises, treatment with certain drugs (pilocarpine), high ambient temperature.

Loss of water with feces in an adult is normal about 200 ml / day. Digestion is accompanied by the release of about 8-10 liters of water with ions dissolved in it into the lumen of the stomach and intestines. In a healthy intestine, almost all of this volume is reabsorbed.

In pathological conditions (diarrhea, vomiting, fistulas, bowel obstruction), the body loses a significant amount of water and ions. In case of violation of the absorption processes from the intestine, transcellular pools are formed that sequestrate a large amount of water and electrolytes. For approximate correction, it is recommended that with the development of intestinal paresis of the II degree, increase the volume of fluid by 20 ml / (kg day), III degree - by 40 ml / (kg day). Corrective solutions should contain sodium, potassium, chlorine, etc.

Frequent vomiting causes a water deficit of an average of 20 ml / (kg day), and correction is best carried out with solutions containing chlorides and potassium.

With moderate diarrhea, fluid replacement is recommended at a rate of 30-40 ml / (kg day), with strong diarrhea - 60-70 ml / (kg day), and with profuse - up to 120-40 ml / (kg day) with solutions containing ions sodium, potassium, chlorine, magnesium.

In case of hyperventilation, it is advisable to administer 15 ml / (kg day) of glucose solution for every 20 respiratory movements above normal. When conducting mechanical ventilation without adequate hydration, up to 50 ml / hour is lost, i.e. ventilation by a device of the RO-6 type during the day requires an additional injection of 1.5 to 2 liters of liquid.

The most ideal and most competent way to correct pathological losses is to determine the composition of the lost media and their quantity. In this case, even using official solutions, it is possible to accurately correct existing violations.

When calculating and selecting various infusion media, there are some difficulties in translating the amount of substance contained in the solution into mmol and vice versa. Therefore, below we present such ratios for the most used substances.

So, in 1 ml contains:

7.4% KCl solution - 1 mmol K + and 1 mmol Cl‾

3.7% KCl solution - 0.5 mmol K + and 0.5 mmol Cl‾

5.8% NaCl solution - 1 mmol Na + and 1 mmol Cl‾

8.4% NaHCO3 solution - 1 mmol Na + and 1 mmol HCO3‾

4.2% NaHCO3 solution - 0.5 mmol Na + and 0.5 mmol HCO‾

10% CaCl2 - 0.9 mmol Ca ++ and 1.8 mmol Cl С

10% NaCl solution -1.7 mmol Na + and 1.7 mmol Cl‾

25% MgSO4 solution - 2.1 mmol Mg ++ and 2.1 mmol SO4 ²‾

1 mol is equal to:

For successful therapy, it is important to determine the ratio of glucose to saline solutions. This ratio will depend on the prevalence of water or electrolyte loss. With isotonic dehydration, it is advisable to maintain a ratio of salt-to-salt solutions of 1: 1, with a water deficiency of 4: 1, and a salt deficiency of 1: 2.

The volume of colloids depends, firstly, on the severity of hemodynamic disturbances and the state of volemia; secondly, from the need for the introduction of blood substitutes for health reasons (for example, in the presence of bleeding - the introduction of plasma, blood).

The choice of the so-called “starting solution” will also depend on the degree of dehydration and its form. Let us explain this idea. The third degree of dehydration occurs with powerful hemodynamic disturbances and should be considered as hypovolemic shock. In this regard, despite the form of dehydration, treatment should begin with drugs that create a volemic effect (albumin, reopoliglyukin, hemodesis), after which it is necessary to proceed with the introduction of fluids depending on the form of dehydration.

So, it is advisable to start treatment of extracellular dehydration (salt-deficient exicosis) with the introduction of an isotonic sodium chloride solution. The introduction of 5% glucose is contraindicated, since its rapid movement into the intracellular sector can cause cerebral edema. In contrast, with cell dehydration, a 5% glucose solution is recommended as a starting solution. Causing some hypotonicity of the extracellular sector, it ensures the saturation of intracellular space with water. With the syndrome of total (general) dehydration, it is recommended to start therapy with an isotonic glucose solution, followed by the transition to the administration of isotonic saline solutions.

When carrying out infusion therapy during cesarean section or during childbirth, it must be remembered that the introduction of glucose solutions before giving birth is indicated only for women with initially low sugar levels. This is due to the fact that the intake of glucose to the fetus through the uteroplacental bloodstream causes hyperinsulinemia, which, after removing the fetus and stopping the glucose from the mother, can cause hypoglycemia and worsen the condition of the newborn. After removing the child, glucose and saline are usually administered in a 1: 1 ratio.

The total volume of fluid needed to correct deficiency and daily requirement depends on the degree of dehydration. An important criterion for its determination are clinical and laboratory data.

The next task that needs to be solved is to determine the time during which it is planned to carry out the correction of dehydration. It is advisable to adhere to the principle that the total volume of injected fluid (enteral and intravenous) should be within 5-9% of body weight and weight gain should not exceed these numbers, because they indicate the limit of the compensatory capabilities of the cardiovascular and urinary systems.

According to V. M. Sidelnikov (1983), the deficit of water and salts should be compensated in 24-36 hours, and 60% of the water deficit should be introduced during the first 12 hours. In patients with heart failure, this period can be increased to 3 to 5 days. Finberg (1980) recommends that half of the daily requirement be introduced in 6-8 hours, and the rest, plus the amount of pathological loss, should be the hours remaining until the end of the day.

Lysenkov S.P., Myasnikova V.V., Ponomarev V.V.

Emergency conditions and anesthesia in obstetrics. Clinical pathophysiology and pharmacotherapy

Water ... Without it, our life would be completely impossible. We know almost everything about water. But we do not know even more. Here are some well-known and unknown facts regarding water. Now many say that you need to drink as much water as possible. However, in this matter one must trust his own body and drink as much as he asks. The generally accepted norms of water consumption are relative and vary depending on the person’s age, gender, well-being, physical activity, the presence of various diseases and the state of the environment.

Some tips on this.

It is better to drink spring water. If you use tap water, it would be nice to either purify it, or boil it, or at least leave it for several hours to weather the smell of bleach

Babies under one year of age who are breastfed quench their thirst with mother's milk. Only in the summer in the heat can they be given 20-30 ml of water between feedings

For 3-5-year-old children, 300-400 ml is enough, for schoolchildren - 400-500 ml of water per day. For an adult - an average of 1.5-2 liters, but starting from 45-50 years, this norm should be reduced to reduce the likelihood of edema

Men need more fluid because they lose it almost a liter more daily than women

It is better to drink water between meals, but it is undesirable to drink food

A glass of water on an empty stomach is very useful for intestinal function. You need to drink 30-40 minutes before breakfast

At night you can drink a glass of warm water. This will help calm down and be a good remedy for insomnia.

Caffeine and alcohol dehydrate the body, so try to drink a glass of water earlier than a cup of coffee or a glass of wine

Before a walk in the cold, it is very good to drink a glass of water or hot tea, because cold and dry air contributes to the loss of fluid by the body (remember puffs of steam in the cold)

There are several formulas for calculating daily water consumption. Here is some of them:

1. Two liters of liquid (or eight glasses) should be consumed by a person weighing 56 kg, and from above it is necessary to add one glass for every 20 kg of weight.

2. A person needs to drink 30-40 ml of water per 1 kg of weight.

3. For 1000 kilocalories received with food, you need to drink 1 liter of water.

4. According to many diets, you need to drink more water to dull the feeling of hunger. But here it is necessary to exercise caution - you can earn water intoxication. And unfortunately, the kilograms dropped in this way quickly gain

5. Drinking more is desirable with diarrhea, because its strong manifestation can cause sudden and rapid dehydration

6. The need for fluid increases with more serious diseases. For example, people who are prone to kidney stones, doctors are advised to drink at least 2.5 liters of water per day to avoid relapses. A lot of fluid is also needed for urinary tract infections. However, in any case, it is better to consult your doctor who will select the correct drinking regimen, taking into account your illness and the effect of the medications you are taking.

Abbreviations:

V- the volume of infusion per day (ml.),   D- fluid deficiency (ml.),   FP physiological need for fluid (ml \\ day),   PP pathological fluid loss (ml / day).   MT - body weight (kg.).

Assess the need for infusion, taking into account the main and concomitant pathology.

To evaluate the possibility of enteral, oral administration of a liquid.

Estimate the initial hydro balance.

Blood loss should be reimbursed according to the methodology (see "Compensation for acute blood loss") in the first hours of therapy.

A) hypertensive

V \u003d ½ D + FP + PP

B) Isotonic

V \u003d 1.0 D + FP + PP

B) Hypotonic

V \u003d ½ D + FP + PP

With normal hydration:

V \u003d 2/3 FP + PP, or V \u003d FP + PP (negative hydro balance must be achieved)

Physiological need is calculated by the formulas:

FP \u003d 30 * MT (up to 65 years)

AF \u003d 25 * MT (65-75 years)

AF \u003d 20 * MT (over 75 years)

Estimated diuresis \u003d 0.6 * AF + infusion load (during forced diuresis), or + excess fluid during hyperhydration.

Pat.potter:

A) Fever - 10% AF - for every degree above 37 ° C

B) Breath -

In spontaneous breathing without shortness of breath, breathing losses are included in AF and comprise 20% (0.2 * AF).

With mechanical ventilation without warming and moistening the mixture (PO-6), add 600 ml / day.

When mechanical ventilation with warming and moistening the mixture st. no breathing losses (+0 ml / day).

With dyspnea over 25 in 1 min. - Add 1 ml \\ kg MT per day for every 1 breath above 25.

D) With an open wound

Min. interventions (inguinal hernia), or open

wound in ICU conditions - 1-2 ml / kg / hour

Average trauma (cholecystectomy) - 2-4

Severe trauma (kish. Obstruction) –4-6

D) Drainages, probes, vomiting, loose stools

Anuric mode (with acute renal failure, terminal stage chronic renal failure)

Diuresis for the previous day + pat. Loss

The composition of the infusion:

AF is provided by saline and glucose * (1: 1)

Drainage, probe, vomiting losses - saline and glucose * (1: 1)

Loss of breathing - glucose only *

At least 1 \\ 3 volume of infusion (in case it exceeds 2400 ml \\ day)

should make colloidal preparations (from a position

electrolyte composition, they are considered as saline solutions).

* 5% glucose solution, considered as a hypotonic, hypoosmolar solution, a source of osmotically free water, is used in the presence of dehydration, after rehydration it is advisable to use a 10% glucose solution, implying it both as a water source and as an energy donor (150 g glucose - 1500 ml . 10% solution - provide minimal nitrogen-saving effect), more concentrated glucose solutions are used as a component of parenteral nutrition.

When conducting parenteral nutrition, solutions of amino acids, lipid emulsions are considered in the total volume of infusion as saline solutions.

• Daily physical fluid requirement

• cerebral edema (and its threat)- the total volume of liquid should not exceed 2/3 of the FP while the I / O part is not more than ½ FP.

• respiratory failure- at the II Art. limit to ½ FP, with DN III Art. - 1/3 FP.

• heart failure- maximum V iv infusion is not more than ½ - 1/3 AF, with hyposystole, complete cessation of IT.

• renal failure- with the exception of prerenal ARF V on / in infusion, not more than the sum of "imperceptible" losses (25 ml / kg / day in young children and 10 ml / kg / day - older) and urine output for the previous day

Clinical Signs of Dehydration

Clinical signs of dehydration (continued)

Infusion rate (cap / min) \u003d

• ... ..volume (ml) ...

• the number of hours of infusion X3

• In shock   behind first hour   introduced 10-15ml / kg

• With exicosis I-II degree   for the first 6-8 hours   rehydration it is advisable to enter (along with nutrition) a volume of liquid approximately equal to its original extracellular volume deficiency:

• CalciumAF \u003d 0.1-0.5 mmol / kg / day

• (in newborns prematurely 1-3 mmol / kg / day)

• Ca chloride 10% \u003d 1 ml \u003d 1 mmol

• Ca gluconate 10% \u003d 1 ml \u003d 0.25 mmol

• Enter 10% rr 0.5 ml / year / day (CaCl) -1 ml / year / day (Ca gluc.)

• (no more than 10 ml), for 1-2 injections

PotassiumAF \u003d 1.0-2.0 mmol / kg / day

• PotassiumAF \u003d 1.0-2.0 mmol / kg / day

• The rate of introduction of K should not exceed 0.5 mmol / kg / hour!

• Enter: - in glucose solution

• - in the presence of diuresis

• - the daily dose is divided into 2 injections

• - the concentration of K in the solution is not more than 1%

• 7.5% solution \u003d 1 ml \u003d 1 mmol

• 4% pp \u003d 1 ml \u003d 0.5 mmol

• We introduce 7.5% solution 1-2 ml / kg / day

• 4% solution 2-4 ml / kg / day

Magnesium   AF \u003d 0.1-0.7 mmol / kg / day

• Magnesium   AF \u003d 0.1-0.7 mmol / kg / day

• 25% \u003d 1 ml \u003d 2 mmol

• Enter in the solution of glucose from the calculation 0.5-1 ml / kg / dayno more than 20 ml for 2 times

• SodiumAF \u003d 2 - 4 mmol / kg / day

• 10% NaCl \u003d 1 ml \u003d 1.71 mmol

• 0.9% NaCl \u003d 10ml \u003d 1.53 mmol

Soda

• Soda

• (correction of decompensated metabolic acidosis)

•   Volume 4% soda (ml) \u003d BE * weight / 2

• The resulting volume is divided by 2,

• we introduce it in the glucose solution 1: 1, repeat CBS

• If there is no CBS, then we introduce 2 ml / kg

• Do not introduce soda in case of ventilation

• It is impossible to strive for complete and quick compensation of acidosis, as soon as the pH reaches the level of 7.25 or more, the infusion is stopped and KCL is administered, since hypokalemia may occur due to the transition of K to the cell

Clinical

• Clinical

• Weight control 2 times a day

• Hourly control of urine output

• Normalization of hemodynamics (heart rate, blood pressure)

• Laboratory

• Biochemical parameters (Electrolytes, glucose, urea, creatinine, protein, KHS, coagulogram)

• Jab with ht

• OAM with specific gravity

The absolute urine count fluid volume

• The absolute urine countallocated for a certain time must be correlated with fluid volumeintroduced into the body for the same time interval.

• It is necessary to maintain an accounting table

Hourly Diuresis

If amid rehydration

• If amid rehydration

• Diuresis does not increase:

• exclude arrester

• possibly excessive saline

• Diuresis exceeds volume   fluid obtained

• introduced excess   solutions containing water (5% glucose)

• due to excess concentrated solutions   glucose in a patient developed osmotic diuresis