Fluid and Electrolyte - Clinical Pathway

by

Jon Scheinman, MD

 

Click the START button to begin.

 

 

 

 

 

 

1. Maintenance Fluids - Weight
Enter the Patient Weight in kg.
Enter amount --->
Select the Patient Habitus.
Normal
Obese
Thin
EXPLAIN  
Patient's Adjusted Weight

 

 

 

 

 

 

2. Maintenance Fluids - Metabolic Rate:
Patient's Adjusted Weight
Select the Metabolic Rate. .
Normal <10 kg
. 10-20 kg
. >20 kg
Basal <10 kg
. 10-20 kg
EXPLAIN >20 kg
Calories
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3. Maintenance Fluids - Insensible Water Loss(ml) Related to Calories
Calories
Select Insensible Water Loss
  Normal (Nl Insensible = 45 ml/100 kCal/d)
If Abnormal, select all that apply
  Dry (Increased Evap = 60 ml/100 kcal)
  Humid (Low Evap 45 - 10 = 35 ml/100 kcal)
  No Respiratory Loss 45 - 30 = 15 ml/100 kcal)
EXPLAIN
Free Water Loss

Water Gain (ml) from Calories Burned
(-12 ml/100 Cal =)
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4. Maintenance Fluids - Obligatory Urine Loss (ml)
Urine Osmols = Output
UV
Urine Need for Osmolar output - select one
Normal Diet - out of the hospital (50cc per 100 Cal)
Lo Osmolar load (20cc per 100 Cal)
Hi Osmolar load (100cc per 100 Cal)
Fixed Low U/O - amount / day
Enter amount---->
Fixed High U/O (high NA) amount / day
Enter amount---->
Fixed High U/O-per day (lo NA) amount /day
Enter amount---->
EXPLAIN    
Urine Loss
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5. Maintenance Fluids - Ongoing Loss: Stool, Pleural, Ascites Loss

Enter ongoing measurable losses. Enter all that apply.

  
Stool, Diarrhea
Enter amount---->
External Loss (Exudate, Transudate, Ileostomy)
Enter amount---->
Third Space (Ascites, Pleura, etc...)
Enter amount---->
Burns
Enter amount---->
EXPLAIN  
Total
Hit the Enter key to clear NaN
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6. Fluid Deficits - Intravascular Depletion (not total dehydration)
Patient's Adjusted Weight
Select Intravascular Depletion
Milliliters

None

Moderate (10cc/kg)

Severe (20cc/kg)

Milliliters of normal saline, D10, or Plasmate or Give Quick. Make a decision.
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7. Fluid Deficits - Repair of Deficit or Excess
Weight Basis  
Select Fluid Deficit  

No Dehydration  

5% Dehydration  

10% Dehydration  

15% Dehydration  

Overload
Enter amount --->
Total Fluid Deficit  
Enter Days to correct (1 or >)
Enter amount --->
Fluid to give in one day  
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8. Exlectrolyte Deficits From Urine Ongoing Loss Replacement
Volume Basis- based on previous data that was entered Volume Na (meq)
Normal = 50cc/100 Cal @ 50 meq/liter
Lo Osmolar = min.osm load, 20cc/100 Cal @ 20meq/liter
Hi Osmolar = usually with Hi NA - @100 meq/l
Fixed Low U/O - amount / day (20 Meq/l)
Fixed High U/O (high Na) amount / day (50 Meq/l)
Fixed High U/O - Per Day (lo Na) amount / day (10 Meq/l)
Meq Na
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9. Electrolyte Deficits From Other Ongoing Losses

Stool, Diarrhea =
 Vol
x 40 meq/l

Meq Na


Ext. Loss (Exud., Trans, Ileo.) =
 Vol
x 120 meq/l

Third Space =
Vol
x 120 meq/l

Burns =
Vol
x 120 meq/l

Total MEQ NA to give
  
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10. Electrolyte Deficits or Excess - Deficits Electrolytes NA
Calculating Sodium Deficit
 Enter Your Patient's Serum Na --->
EXPLAIN Serum TBW Deficit/l NA Deficit
From Volume Deficit
Isotonic
Hypertonic
Hypotonic
Total
Ongoing losses - urine
Ongoing measured
Total NA
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11b. Electrolyte Deficits or Excess - Summary and Na Balance
Name Email
.
Water Na
Volume needed Per 24 hrs Per 8 hrs . Per 24 hrs Per 8 hrs
Insensible water . . .
Gain - Water hydration
Urine From onging losses - urine
Ongoing losses - measurable Ongoing losses - measurable
Deficit (total to correct 24/8 hrs) From volume deficit
.
Volume sub-total Na sub-total
.
. Isotonic
Hypertonic (excess/day corrected over 2 days)
Hypotonic
.
Add water for Na excess (negative Na required) Total Na Required
Total water required Concentration Na (meq/l)