Different Fluids Flashcards
This is a list of fluids that the textbook made its own section
Albumin (Albumarc, Albutein, Flexbumin)
Type: Colloid, Blood modifier agent, Volume expander
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MOA:
Oncotically similar to human plasma; Causes the body to shift approximately 3.5 times the amount administered into the intravascular space
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Indications: Hypovolemia
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Contraindications: Hypersensitivity | Patients at risk of hypervolemia | Use with caution in patients with renal insufficiency or anemia
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Adverse Reactions: N/V | Itching/hives | Abdominal pain | Angioedema | Dysrhythmias | Bronchospasm
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Drug Interactions: N/A
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Dosages:
Dose rate adjust to pt needs
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Duration: Onset: 15 to 30 minutes | Peak effect: unknown | Duration: 24 hours
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Special Conditions: Pregnancy safety: Category C | Administered with 0.9% NS, D5W, or sodium lactate
Hetastarch (Hespan)
Type: Artificial colloid
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MOA:
A starch-containing colloid used as an intravascular volume expander | Following administration, the plasma volume is expanded slightly more than the volume of Hetastarch; this effect has been overved for up to 24 to 36 hours | Hetastarch increases intravascular volume by virtue of its colloid osmotic pressure
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Indications: Hypovolemic shock, especially burn shock | Septic shock
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Contraindications: No significant contraindications when used in the management of life-threatening hypovolemic states
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Adverse Reactions: N/V | Mild febrile reactions | Chills, itching, urticaria | Rare severe anaphylactic reactions have been reported
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Drug Interactions: Should NOT be administered to patients who are receiving anticoagulants | Patients allergic to corn may be allergic to hetastarch
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Dosages:
Titrate according to the patient’s physiologic response
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Duration: Duration: 24 to 36 hours
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Special Conditions: Pregnancy Safety: Category C
Plasma Protein Fraction (Plasmanate)
Type: Natural colloid
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MOA:
Protein-containing colloid that remains in the intravascular compartment | Increases intravascular volume by attracting water from other fluid compartments by virtue of its colloid osmotic pressure
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Indications: Hypovolemic shock, especially burn shock | Hypoproteinemia (low-protein states)
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Contraindications: No significant contraindications when used to treat life-threatening hypovolemic states
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Adverse Reactions: Chills, fever, hives, N/V
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Drug Interactions: Solutions should NOT be mixed with or administered through the same administration sets as other IV fluids
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Dosages:
Titrate according to the patient’s hemodynamic response
In the management of shock secondary to burns, the physician’s orders regarding the administration rate must be closely followed
The medical control physician uses standard formulas to determine the correct rate of IV administration
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Duration: Duration: 24 to 36 hours
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Special Conditions: Do NOT use if the solution is cloudy or if sedimentation is seen
0.9% Sodium Chloride (Normal Saline)
Type: Isotonic crystalloid solution
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MOA:
Replaces water and electrolytes
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Indications: Heat-related problems (heat exhaustion, heatstroke) | Freshwater drowning | Hypovolemia | Diabetic ketoacidosis | Keep open IV
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Contraindications: Avoid in patients with history of heart failure or renal failure because circulatory overload can be easily induced
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Adverse Reactions: Rare with therapeutic dosages
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Drug Interactions: Few in the emergency setting
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Dosages:
Infusion rate will depend on the specific situation being treated.
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Duration: Short-term therapy
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Special Conditions: N/A
0.45% Sodium Chloride
Type: Hypotonic crystalloid solution
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MOA:
Replaces water and electrolytes
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Indications: Patients with diminished renal or cardiovascular function for whom rapid rehydration is not indicated
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Contraindications: Cases in which rapid rehydration is indicated
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Adverse Reactions: Rare with therapeutic dosages
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Drug Interactions: Few in the emergency setting
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Dosages:
The specific situation and patient condition will dictate the rate at which one-half normal saline is administered
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Duration: Short-term therapy
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Special Conditions: N/A
Lactated Ringer Solution (Hartmann Solution)
Type: Isotonic crystalloid solution
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MOA:
Replaces water and electrolytes
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Indications: Hypovolemic shock | Keep open IV, hypoperfusion
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Contraindications: Heart failure or renal failure | Avoid use in patients with crush injuries/compartment syndrome
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Adverse Reactions: Rare with therapeutic dosages
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Drug Interactions: Few in the emergency setting
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Dosages:
Hypovolemic shock: titrate according to the patient’s physiologic response
Hypoperfusion: 20 mL/kg IV/IO over 15 minutes; repeat as needed for ongoing hypoperfusion
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Duration: Short-term therapy
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Special Conditions: N/A
3% Sodium Chloride (Hypertonic Saline)
Type: Hypertonic crystalloid solution
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MOA:
Osmotic effect allows fluid to cross the blood-brain barrier, reducing the amount of fluid in the cranial cavity and decreasing the ICP
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Indications: Traumatic brain injuries | Fluid resuscitation in severe sepsis | Hyponatremia
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Contraindications: Hypotension | Use with caution in pediatric patients because their sodium levels shift rapidly | Rapid increases can cause significant neurologic complications
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Adverse Reactions: Increases sodium levels | Seizures | Neurologic deficits
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Drug Interactions: None currently identified
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Dosages:
Infusion rate will depend on the specific situation being treated
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Duration: Onset: Rapid | Peak effect: Unknown | Duration: Unknown
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Special Conditions: Should be administered through a central line due to its high osmolarity and tonicity
5% Dextrose in 0.45% Sodium Chloride
Type: Hypertonic dextrose-containing crystalloid solution
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MOA:
Replaces free water and electrolytes and provides nutrients in the form of dextrose
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Indications: Heat exhaustion, diabetic disorders | KVO solution (keep veins open solution) in patients with impaired renal or cardiovascular function
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Contraindications: Should NOT be used when rapid fluid resuscitation is indicated
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Adverse Reactions: Rare with therapeutic dosages
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Drug Interactions: Should NOT be used with phenytoin (Dilantin) or amrinone (Inocor)
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Dosages:
Infusion rate will depend on the specific situation being treated
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Duration: Short-term therapy
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Special Conditions: N/A
5% Dextrose in 0.9% Sodium Chloride
Type: Hypertonic dextrose-containing crystalloid solution
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MOA:
Replaces free water and electrolytes and provides nutrients in the form of dextrose
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Indications: Heat-related disorders | Freshwater drowning | Hypovolemia | Peritonitis
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Contraindications: Should NOT be administered to patients with impaired cardiac or renal function
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Adverse Reactions: Rare with therapeutic dosages
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Drug Interactions: Should NOT be used with phenytoin (Dilantin) or amrinone (Inocor)
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Dosages:
Infusion rate will depend on the specific situation being treated
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Duration: Short-term therapy
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Special Conditions: N/A
5% Dextrose in Lactated Ringer Solution
Type: Hypertonic dextrose-containing crystalloid solution
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MOA:
Replaces free water and electrolytes and provides nutrients in the form of dextrose
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Indications: Hypovolemic shock | Hemorrhagic shock | Some instances of acidosis
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Contraindications: Should NOT be administered to patients with impaired cardiac or renal function
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Adverse Reactions: Rare with therapeutic dosages
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Drug Interactions: Should NOT be used with phenytoin (Dilantin) or amrinone (Inocor)
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Dosages:
Infusion rate will depend on the specific situation being treated
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Duration: Short-term therapy
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Special Conditions: N/A
Total Parenteral Nutrition
Type: Electrolyte, Nutrition
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MOA:
Replenishes electrolyte and nutrients
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Indications: Ordered and customized to each patient based on needs identified from lab work
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Contraindications: Vary based on the specific mixture
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Adverse Reactions: Vary based on the specific mixture
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Drug Interactions: Vary based on the specific mixture
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Dosages:
Vary based on the specific mixture
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Duration: Vary based on the specific mixture
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Special Conditions: Vary based on the specific mixture
Dextran
Type: Artificial colloid
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MOA:
A sugar-containing colloid used as an intravascular volume expander | Remains in the intravascular compartment for approximately 12 hours | Increases intravascular volume by attracting water from other fluid compartments by virtue of its colloid osmotic pressure
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Indications: Hypovolemic shock
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Contraindications: Known hypersensitivity | Heart failure, renal failure, or known bleeding disorders
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Adverse Reactions: Rash, itching, dyspnea, chest tightness, mild hypotension | Incidence is very low, and reactions are generally mild | Increased bleeding time has also been reported due to the interference of dextran with platelet function
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Drug Interactions: Should not be administered to patients receiving anticoagulants because it significantly slows blood clotting
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Dosages:
Titrate according to the patient’s physiologic response
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Duration: Duration: 8 to 12 hours
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Special Conditions: In the management of burn shock, it is essential to follow standard fluid resuscitation regimens to prevent possible circulatory overload
Bacteriostatic Water
Type: Diluent or Solvent
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MOA:
Works as a solvent or dilutional agent
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Indications: Used for diluting or dissolving drugs for IV, IM, or subcutaneous injections based on the drug manufacturer’s recommendations
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Contraindications: Hypersensitivity to benzyl alcohol due to use as a preservative
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Adverse Reactions: None noted if used according to the manufacturer’s recommendations
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Drug Interactions: N/A
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Dosages:
According to the drug manufacturer’s recommendations
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Duration: N/A
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Special Conditions: Pregnancy category: C | Due to the presence of a benzyl alcohol additive, other dilutional agents should be used if available | Solution should be made approximately isotonic before use
5% Dextrose in Water
Type: Hypotonic dextrose-containing solution
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MOA:
Provides nutrients in the form of dextrose as well as free water
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Indications: IV access for emergency drugs; Dilution of concentrated drugs for IV infusion
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Contraindications: Should NOT be used as a fluid replacement for hypovolemic states
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Adverse Reactions: Rare with therapeutic doses
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Drug Interactions: Should NOT be used with phenytoin (Dilantin) or amrinone (Inocor)
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Dosages:
Usually administered through a minidrip (60 drops/mL) set at a TKO (to keep open) rate
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Duration: Short-term therapy
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Special Conditions: D5W should NOT be administered simultaneously with blood through the same IV administration set because of the possibility of hemolysis.
10% Dextrose in Water
Type: Hypertonic dextrose-containing solution
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MOA:
Provides nutrients in the form of dextrose as well as free water
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Indications: Neonatal resuscitation | Hypoglycemia
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Contraindications: Should NOT be used as a fluid replacement for hypovolemic states
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Adverse Reactions: Rare with therapeutic doses
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Drug Interactions: Should NOT be used with phenytoin (Dilantin) or amrinone (Inocor)
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Dosages:
Infusion rate is usually dependent on the patient’s condition
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Duration: Short-term therapy
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Special Conditions: N/A
