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The use of isotonic fluids

Surgical patients most prone to this lack of water; water and sodium loss, serum sodium in the normal range, Extracellular Fluid osmolality have remained normal. It results in the extracellular fluid volume (including the circulating blood volume) rapidly decreased due to the loss of fluid is isotonic, without substantially changing the osmolality of the extracellular fluid, intracellular fluid initially did not transfer to the extracellular space, compensatory reduction in extracellular fluid and intracellular fluid volume does not change. But this fluid loss continues for a long time after, intracellular fluid will be gradually moved out, losing along with the extracellular fluid, resulting in cell water.

Clinical manifestations.

Patients do not thirst, scanty urine, loss of appetite, nausea, fatigue, dry tongue, enophthalmos, dry skin, relaxation and other symptoms. Lose too much in the short term, loss of fluid when the weight of 5%, is lost when the extracellular fluid 25%; pulse fine speed, acromegaly in patients and wet, unstable or fall in blood pressure and other symptoms of hypovolemia. Fluid continues to lose weight 6%~7%; considerable loss of the extracellular fluid of 30%~35% when shock have shown that they are serious. Often accompanied by metabolic acidosis. If the patient loses body fluids mainly gastric juice, CL-mass loss may be associated with metabolic alkalosis, alkalosis occurs some of the clinical manifestations.


First of isotonic dehydration caused by reasons as far as possible, in order to reduce the loss of water and sodium. Reductions in the extracellular fluid, isotonic saline or balanced salt solution for additional blood volume as soon as possible. According to the pulse of light speed and drop in blood pressure and other symptoms to estimate the volume of fluid loss, has amounted to 5% of body weight, can quickly enter the above liquid 3.0L (calculated by weight 60kg). In order to restore blood volume or blood cell volume to calculate the amount of filling liquid required. Filling volume of isotonic saline (l) = blood cell volume rise x weight (kg) x0.25 blood volume to normal. In addition, you should also supply requirements on the day, typically a water 2.0L and sodium 4.5G.

Isotonic saline containing na + and CL-154mmol/L, and the serum content of NA + and CL-are 142mmol/L and 103mmol/L respectively. In comparison, isotonic saline Cl-content higher than that of serum Cl-in 50mmol/L, in a State of severe water shortages, or shock, reduced renal blood flow, affecting the function of chloride, much lost to isotonic saline from the vein, and lead to excessive blood Cl-, cause high danger of chloride acidosis. Therefore, the application of isotonic saline in treating water there are a number of shortcomings. Balanced salt solution similar in the electrolyte levels and the plasma, used to treat water shortage more physiologic, entered too many Cl-can be avoided, and to help correct acidosis. In addition, after you correct the shortage of water and an increase in the excretion of potassium, k + concentrations would be diluted due to increased extracellular fluid volume decreased incidence of hypokalemia should be paid attention to. Potassium chloride should be added in the urine after 40ml/h.