Fluid Administration Flashcards
Describe the pharmaceutics of hypertonic saline
CVC only
Stable in storage
10ml contains 2g of salt, 20g per 100ml
pKa 3.09, good water solubility, osmolality 6840 mosm/kgh
What is the osmolality of hypertonic saline?
CVC only
Stable in storage
10ml contains 2g of salt, 20g per 100ml
pKa 3.09, good water solubility, osmolality 6840 mosm/kg
What ist he pKA of hypertonic saline
CVC only
Stable in storage
10ml contains 2g of salt, 20g per 100ml
pKa 3.09, good water solubility, osmolality 6840 mosm/kg
What is the osmolality of hypertonic saline
CVC only
Stable in storage
10ml contains 2g of salt, 20g per 100ml
pKa 3.09, good water solubility, osmolality 6840 mosm/kg
What additional organ action does hypertonic saline have aside from osmolality, circulating volume icnrease
Anti-inflammatory
What are the side effect of hypertonic saline?
Metabolic acidosis (NAGMA) – hyperchloraemia
Hypokalaemia
Seizures (sodium fluctuations)
Coagulopathy (apt/INR)
Altered platelet aggregation
What is the duration of action of hypertonic saline?
130 minutes of ICP effectO
Onset of hypertonic saline ffect
<1 minutes
Vd and distirbution of hypertonic saline?
Vd 0.2L/kg, confined to ECF – 25% intravascular 75% ISF
pH of 0.9% saline
9g NaCl; IV/SC/orally or as a neb. Clear colourless solution, non pyrogenic heat stable packaging
8.8g of NaCl added to water, pKa 3.1
pH 4.5-7
How many g of salt in 1 L of 0.9% saline?
9g NaCl; IV/SC/orally or as a neb. Clear colourless solution, non pyrogenic heat stable packaging
8.8g of NaCl added to water, pKa 3.1
pH 4.5-7
pka of saline
9g NaCl; IV/SC/orally or as a neb. Clear colourless solution, non pyrogenic heat stable packaging
8.8g of NaCl added to water, pKa 3.1
pH 4.5-7
What effect does 1L of saline have on volume
Volume expansion fo the IV by 25% of the infused volume after 25-30 minutes, below circulatory reflex activation threshold. Effect greater prior to redistribution.
What effect does 1L of saline have on Na
0.5-1mmol/L
What effect does 1L of saline have on Cl
3mmol/L rise
What effect does 1L of saline have on bciarbonate
decrease by 3mmol/L
What effect does 1L of saline have on osmoreceptors
0.2mosm/kg change
Therefore <1% and no change
What effect does 1L 0.9% saline have on oncotic pressure? How is this corrected?
Osmoreceptors not activated – as change is 0.2mosm/kg (<1% or <2.8mosm/kg), dilution of oncotic pressure drop from 30mmHg to 28.5mmHg glomerulotub. Bal
What effect does 1L of hartmans have on Na and Cl
Trivial sodium elevation 0.5-1mmol/L, chloride elevation up to 3mmol/L, decreased bicarbonate and base excess up to 3mmol/L. Osmoreceptors not activated – as change is 0.2mosm/kg (<1% or <2.8mosm/kg), dilution of oncotic pressure drop from 30mmHg to 28.5mmHg glomerulotub. Bal.
For Hartamns ½ rise in Na and Cl.
What si the pH of hartmains
5-7
What is the electrolyte content of NaCl
154 Na
154 ClW
What is the osmolality of saline?
286 measured (freezing point) (308 calculated)
What is the electrolyte content of Hartmans
131mmol Na
5mmol K
2mmol Ca
112mmol Cl
28mmol lactate – metabolised not osmotically active
What is the electrolyte content of Plasmoluyte
140 Na
5 K
1.5mmol Mg
23mmol gluconate
27mmol acetate
98mmol Cl
What is the pH of plasmolyte
7.4
What is the Osmolality of Hartmans
276 (effective osmolality is 248)
What is the osmolality of Plasmalyte?
294mosm calc. 244 reality
What it he duration of action of saline
20-40 minutes in health euvolaemic longer in shock up to 8hrs (RAAS)
What is the duration of action of 1L of hartmans or plasmolyte?
50% of infused volume out of IV space in 30mins, finishes in another 30min
What is the bioavailability and absorption of saline
100% bioavailability, well absorbed
What is the Vd of saline?
0.2L/kg, in ECF 25% intravascular – 250mls – redistribution delay means during infusion ~400-450mls
75% interstitial – 750mls
1L fo saline results in what response in circulatory reflexes?
Below circulatory reflex activation 5%, volume expansion maximal prior to redistribution(during infusion) . See action at other organ system for electrolyte and osmolality effects
What is the redistribution of Hartmans after 1L is given? Baroreceptors affected? Osmolality?
900ml extraC, 100ml intraC, 25:75 ratio leaves 225ml IV. Below Baroreceptor.
No lactic acidosis (no H+ ion) – incorporated in ciritc acid cycle consuming H+ion (decreased total body acidity) making CO2
1L = 9 calories. Osmolality change 1mmol/L change <1%.
What is the fate of lactate in hartamns
900ml extraC, 100ml intraC, 25:75 ratio leaves 225ml IV. Below Baroreceptor.
No lactic acidosis (no H+ ion) – incorporated in ciritc acid cycle consuming H+ion (decreased total body acidity) making CO2
1L = 9 calories. Osmolality change 1mmol/L change <1%.
What effect does plasmolyte have on IV fluid post 1L total given? What effect does it have on osmolaliuty?
Same as Hartmans but 227mls IV. Osmo ~3%
Acetate enter citric acid cycle CO2 and water (consume H+ ion)
1L 15calories. K+ inside cells, Mg mostly extracell. Gluconate excreted in urine unchanged.
What is the fate of acetate in plasmolyte
Same as Hartmans but 227mls IV. Osmo ~3%
Acetate enter citric acid cycle CO2 and water (consume H+ ion)
1L 15calories. K+ inside cells, Mg mostly extracell. Gluconate excreted in urine unchanged.
What is the fate of gluconate in plasmolyte?
Same as Hartmans but 227mls IV. Osmo ~3%
Acetate enter citric acid cycle CO2 and water (consume H+ ion)
1L 15calories. K+ inside cells, Mg mostly extracell. Gluconate excreted in urine unchanged.
Describe the pharmaceutics of 5% dextrose?
Crystalloid fluid – isotonic monosaccharie solution
50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents
pKa 12.9 i.e. non ionised, water solubility
pH 3.5 – 6.5 (regardless of conc of glucose)
pKa of dextrose 5%
Crystalloid fluid – isotonic monosaccharie solution
50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents
pKa 12.9 i.e. non ionised, water solubility
pH 3.5 – 6.5 (regardless of conc of glucose)
pH of 5% dextrose
Crystalloid fluid – isotonic monosaccharie solution
50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents
pKa 12.9 i.e. non ionised, water solubility
pH 3.5 – 6.5 (regardless of conc of glucose)
Where does dextrose come from for the manufactuer of fluids/
Crystalloid fluid – isotonic monosaccharie solution
50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents
pKa 12.9 i.e. non ionised, water solubility
pH 3.5 – 6.5 (regardless of conc of glucose)
Describe the redistribution of 5% dextrose
Expands extracellular fluid volume and ICF – 8% of infused volume after 15-20 minutes remains intravascular. 2.5% change in osmolality sensed by OVLT osmosesnor leading to decreased vasopressin release and diuresis.
What is the change in osmolality after 1L fo dextrose is infused?
Expands extracellular fluid volume and ICF – 8% of infused volume after 15-20 minutes remains intravascular. 2.5% change in osmolality sensed by OVLT osmosesnor leading to decreased vasopressin release and diuresis.
Side effects of 5% dextrose
Hyperglycaemia + Hyponatraemia
Higher concentration dextrose RBC lysis (hyperosmolar fluid out of RBC) thrombosis and phlebitis
Osmolality fo 5% dextrose
250 (calculated 278mmol/L 278mosm/L) –
(556 for 10%, 2780 for 50%)
Half life of volume expansion from 5% dextrose
15-20 minutes
Vd of 5% dextrose? Redistribution volumes
Vd 0.6L/kg – distributed widely after 20 minutes
- 66% intracellular 660mls
- 26% intersitital 260mls
- 8% intravascular 80mls
Metabolic fate of 5% dextrose?
Each glucose metabolised by all tissues with aerobic metabolism to 6H20 and 6CO2 but especially the liver – thus from 1L makes extra 30ml of fluid
Eliminated by kidney and lungs
Effect on electrolytes and osmolality of 5% dextrose 1L being given?
Below circulatory threshold (80ml^ = 1.5%)
2.5% change in osmolality (6.5mmol) OVLT stimulated and decreased vasopressin (diuresis).
Na drop 4mmol/L angiotensin 2 + aldosterone ction
Decrease bicarbonate and base excess 3mmol/L
198 calories
What is the OVLT
Organum vaculosum laminae terminalis
Circumventricular organs
Where does albumin come from?
Concentrated human plasma albumin/ Colloid - From multiple whole blood donor/ plasma apheresis collection.
How is albumin prepared from blood?
Ethanol fractionation or chromatographic separation methods. Pasteurised by heat at 60 degrees for 10 hours. Octanoate preservative weakly antimicrobial and antifingual, stops denaturing in pasteurisation