Intravenous Fluids Flashcards by Mavis Mawuena

Preoperative evaluation of fluid states

Mental status
Skin turgor
Bp
Heart rate
Urinary output
Central venous pressure
Input output chart

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Orthostatic hypotension

Systolic blood pressure drop of about 20mmHg from supine to standing.
Indicates loss of 6-8% fluid deficit.

One of the immediate signs of dehydration

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Composition of iv fluids

Crystalloids
Colloids
Or both

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Indications for IV fluids

Volume rescucutation in severe fluid loss

Vehicle for iv drugs

Needed to keep the veins open. I.e in shock

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Crystalloids

Clear fluid made of water and electrolute solutions. It crosses semi permeable membrane

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Crystalloids grouped into?

3
Isotonic
Hypertonic
Hypotonic

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Most common iv fluids given?

0.9% Nacl. Normal saline

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Normal saline and plasma

Are isosmolar

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Conc of na and cl in normal saline?

154mmol/l each

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Ph of normal saline?

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Osmolarity of normal saline

308mOsm/l

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Indications of normal saline

Used to replace lost fluids and electrolytes

To dilute drugs

To dilute packed RBCs

Intravascular rescucitation

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Advantage of notmal saline

A greater portion of it Stays entirely in ecf

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Disadvantage of notmal saline

When given in excess can produce hyperchloremic metabolic acidosis

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Electrolyte content of 3% saline

513mmol/l

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Osmarity of 3% saline

1026mosm/l

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Ph of 3% saline

5.0

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Indications of 3% saline

In severe hyponatremia

To rescucutate hypovoleamic shock

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Disadvantages of 3% saline

Must be administered via cv line, slowly because it can cause phlebitis, necrosis, or hemolysis.

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Complications of 3% saline.

Edema

Severe renal insufficiency

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Precautions in giving 3. % saline

Precautions in patients with chronic hear failuire

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Composition of 5% dextrose

50g/dl glucose

No sodium and chloride, pittasium,calcium

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Ph of5% dextrose

4.5

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Osmolarity of 5% dextrose

2520 mosm/l

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Indications of 5%dextrose

Hypernatremia To maintain fluid balance in people who cant take anything by mouth Used postoperatively in conjunction with salt retaining fluids

This iv fluid cannot be used in rescicitation

5% dextrose. | Only used for short quick results

Side effects of 5% dextrose

Iatrogenic hyponatremia Induces hyperglycemia Hemolysis cos its not compatible with blood

Most physiological soln if crystalloids

Ringers lactate. Urs electrolyte composition same as ecf

Osmolarity of ringers lactate

273mmos/l

Ph of ringers lactate

6.5

Lactate in ringers lactate converted to?

Hco3 in liver

Indications of ringers lactate

Intraoperative fluid loss Severe hypovoleamia

Precautions for ringers lactate

Severe metabolic acidosis | Dont give with blood products cos calcium in it chelates antocoagulant calcium in blood

Dextrose in normal saline contains

0.9% saline, 5% dextrose Cl and Na-154mmol/l with 5gr glucose

Indication of isolyte p

Pediatric maintenance fluid

Indication of dns

Maintenance of fluid Provides both energy and electrolyes Compatible with blood

Isolyte P contains

Multiple electrolytes and dextrose

Examples of crystalloid iv solutions

``` Isolyte p Dextrose in normal saline Ringers lactate Normal saline 3% saline 5% dextrose ```

Colloids

Do not cross semi permeable membrane easily hence are always contained in intravascular space- plasma expanders

Disadvantages of colloids. Why does it put patient at risk

Are gelatinous and cause platelet dysfunction. Interfere with fibrinolysis and coagulation factor 8 leading to coagulopathy

Types of colloids

Albumin Dextran Gelatins Hydroxyethyl startches

Albumin

Already a natural major component of plasma 50-60% of plasma proteins

Half life of albumin

20 days

Types of solutions of albumin

2. | 5% and 25% form

5% albumin solution

Isosmotic with plasma 80% volume expansion recorded

25% albumin solution

200-400% increase in volume

Indications of albumim solution

Loss of plasma leading to shock in emergency i.e in burns Fluid rescucitation in icu Hypoalbumineamia

Side effects of albumin

Pruritis due to antigen antibody reaction Anaphylactoid reactions Coagulation abnormalities compared to synthetic colloids

Disadvantages of albumin solution

Very expensive | Volume overload which cam cause edema

Dextran is

Highly branched polysacharide | Produced by bacteria

Types of dextran

6% dextran or dextran 70 | 10% dextran or dextran 40

Dextran excreted primarily by

Kidneys

Uses of dextran

Used to improve microcirculation | Used in extracorporal circulation

Disdvantages of dextran

Anaphylactic reactions Coagulopathies Interfere with cross matching Precipitates renal failuire

What are gelatins

Large molecular weight substances formed from hydrolysis of collagen 70-80% volume expansion

Indications for gelatin

Rapid volume expansion of intravascular volume

Advantages of gelatin

Not expensive No renal failuire No coagulation inpairment

Disadvantages of gelatin

Hypersensitivity | Anaphylactoid reactions

What are hydroxy ethyl starches

Derived from amylopectin

Types of hydroxyethyl starches

6% isosmolar with plasma | 10% hyperosmaolar with plasma

Advantages of HES

Cost effective | Comparable volume expansion yo albumin

Disadvantages

Anaphylactoid reactions Coagulopathy Renal impairment Increased amylase level

Why colloids are not used as sole fluid replacement in rescucitation?

This is because colloids stay exclusively in the intravascular space or vessels and even cause more water to be drawn from the interstitial space into it so you have to add crystalloids which will push some fluid into the interstitial space