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APPLIED PHARMACOLOGY💊 > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

Colloids (Plasma Substitutes) -

Examples

A
  • Gelatins

- Albumin

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2
Q

Colloids (Plasma Substitutes) -

Indications

A
  • Colloids are used to expand circulating volume in states of impaired tissue perfusion (shock)
  • In cirrhotic liver disease : albumin is used to prevent effective hypovolaemia in large-volume paracentesis (ascitic fluid drainage)
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3
Q

Colloids (Plasma Substitutes) -

MOA

A
  • Intravenous (IV) colloid preparations contain comparatively large, osmotically active molecules, such as albumin or modified gelatin, in solution or suspension.
  • In principle, these molecules cannot readily cross a semipermeable membrane (including vascular endothelium) and their osmotic effect ‘holds’ the infused volume in the intravascular compartment.
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4
Q

Colloids (Plasma Substitutes) -

Adverse Effects

A
  • Oedema
  • Pulmonary oedema : excessive plasma volume expansion —> increase left ventricular filling –> decrease cardiac output (startling cruve) –> PO
  • Hypersensitivity reactions (anaphylaxis)
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5
Q

Colloids (Plasma Substitutes) -

Caution

A

1) Heart failure

2) Renal impairement

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6
Q

Colloids (Plasma Substitutes) -

Interactions

A

No clinically important interactions

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7
Q

Colloids (Plasma Substitutes) -

Monitoring

A
  • Close monitoring of haemodynamic status
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8
Q

Colloids (Plasma Substitutes) -

Patient Education

A
  • Used to improve BP
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9
Q

Crystalloid - examples

A

1) Hartmann’s Solution - Compound sodium lactate
2) Glucose - Dextrose
3) Sodium Chloride

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10
Q

Hartmann’s Solution - Indication

A

1) To provide sodium and water in patients unable to take enough orally.
2) To expand circulating volume in states of impaired tissue perfusion (including shock).
- This may be done as a ‘fluid challenge’, where a bolus of fluid (e.g. 500 mL) is infused rapidly.

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11
Q

Hartmann’s Solution - MOA

A
  • Compound sodium lactate is a balanced crystalloid solution.
  • Its electrolyte composition approximates serum: one litre contains Na+ 131 mmol, Cl– 111 mmol, K+ 5 mmol, Ca2+ 2 mmol and lactate 29 mmol.
  • The infused lactate is readily metabolised, generating bicarbonate.
  • This makes it a suitable choice for providing sodium and water in patients unable to take enough orally.
  • As compound sodium lactate contains sodium in a concentration similar to extracellular fluid, the infused volume is largely retained in the extracellular water compartment.
  • As intravascular water accounts for about 20% of extracellular water, about 20% of the infused volume will remain in vessels to expand circulating volume.
  • This makes it a viable choice for use in fluid resuscitation.
  • Its main advantage over sodium chloride 0.9% is its lower chloride content, making it less likely to cause hyperchloraemic acidosis.
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12
Q

Hartmann’s Solution - Adverse Effects

A
  • Oedema : sodium diffusion into interstitium promotes oedema
  • Pulmonary oedema
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13
Q

Hartmann’s Solution - Contraindications

A
  • Severe liver disease : may not have enough capacity to metabolise lactate
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14
Q

Hartmann’s Solution - Caution

A

1) Heart Failure - due to risk of pulmonary oedema

2) Renal impairement

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15
Q

Hartmann’s Solution - Interactions

A

None

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16
Q

Hartmann’s Solution - Monitoring

A
  • Haemodynamic status

- Fluid balance

17
Q

Hartmann’s Solution - Patient Education

A
  • Fluid is given because pt unable to take enough by mouth

- Drink more

18
Q

Glucose - Indication

A

1) Glucose 5% = used to provide water in patients unable to take enough orally.

2) Glucose 10%, 20% and 50% = are used to treat hypoglycaemia when this is severe or cannot be treated orally.
- -> Glucagon is an alternative.

3) Glucose 10%, 20% and 50% = used with insulin to treat hyperkalaemia.
- -> Calcium gluconate may also be given in this setting (to stabilise the myocardium).

4) Glucose 5% = used for reconstitution and dilution of drugs intended for administration by injection or infusion.
- -> Sodium chloride 0.9% and sterile water are alternatives

19
Q

Glucose - MOA

A
  • Glucose (C6H12O6) is a monosaccharide that is the principal source of energy for cellular metabolism.
  • It exists in several isomeric configurations: D-glucose (dextrose) is most relevant in mammalian biology.
  • Glucose 5% solution is primarily a means of providing water.
  • The glucose content ensures it is initially isotonic with serum, so that it does not induce osmotic lysis of red cells on initial mixing with blood.
  • Glucose is rapidly taken up by cells and metabolised, leaving ‘free’ (hypotonic) water that distributes across all body water compartments.
  • Higher-concentration glucose solutions are used to treat hypoglycaemia; the mechanism for this is self-explanatory.
  • In hyperkalaemia, soluble insulin is given to stimulate Na+/K+-ATPase and shift potassium into cells.
  • In this context, glucose is given to prevent hypoglycaemia.
  • As less than 10% of an infused glucose solution remains in the intravascular space, it not used to expand circulating volume
20
Q

Glucose - Adverse Effects

A
  • Glucose 50% = irritant to veins

- Hyperglycaemia

21
Q

Glucose - Interactions

A

Glucose + Insulin have antagonistic effects

22
Q

Glucose - Monitoring

A
  • Fluid balance : input + output

- Plasma electrolytes : serum glucose and potassium conc

23
Q

Glucose - Monitoring

A
  • Fluid balance : input + output

- Plasma electrolytes : serum glucose and potassium conc

24
Q

Sodium Chloride - Indications

A

1) Sodium chloride 0.9% and 0.45% = used to provide sodium and water in patients unable to take enough orally.

2) Sodium chloride 0.9% = used to expand circulating volume in states of impaired tissue perfusion (including shock).
- -> Compound sodium lactate and colloids are alternatives.

3) Sodium chloride 0.9% = used for reconstitution and dilution of drugs intended for administration by injection or infusion.
- -> Glucose solutions and sterile water are alternatives.

25
Q

Sodium Chloride - MOA

A
  • The extracellular fluid (ECF) compartment is made up of intravascular water (about 20%) and interstitial water (about 80%).
  • Sodium is partitioned into ECF by Na+/K+-ATPase on cell membranes, which pumps sodium out of cells in exchange for potassium.
  • As the main cation in ECF, sodium is the principal determinant of its osmolality.
  • Osmolality is tightly regulated within a narrow range, so an increase in body sodium content (e.g. due to administration of a sodium-containing fluid) leads to an increase in ECF volume.
  • The amount by which it expands depends on the sodium concentration of the fluid relative to ECF.
  • Sodium chloride 0.9% contains sodium 154 mmol/L, similar to that of ECF.
  • Accordingly, ECF expands by approximately the same amount as the volume of sodium chloride 0.9% administered.
  • This distributes between the intravascular and interstitial compartments, so about 20% of the volume administered remains in vessels to expand circulating volume.
  • Sodium chloride 0.9% and 0.45% are also used to provide sodium and water if the patient’s requirements cannot be met orally.
26
Q

Sodium Chloride - Adverse Effects

A
  • Oedema
  • Pulmonary oedema
  • Hyperchloraemia: The concentration of chloride in sodium chloride 0.9% is significantly higher than that of ECF–> promoting acidaemia
27
Q

Sodium Chloride - Caution

A
  • Heart Failure –> risk of pulmonary oedema

- Renal impairment –> monitor to avoid overload

28
Q

Sodium Chloride - Monitoring

A
  • Fluid balance

- Haemodynamic status

29
Q

Sodium Chloride - Patient Education

A
  • Treatment due to unable to take enough fluid. by mouth

- Ask patient to report any irritation, swelling or wetness around the cannula

30
Q

Sodium Chloride - Patient Education

A
  • Treatment due to unable to take enough fluid by mouth

- Ask patient to report any irritation, swelling or wetness around the cannula

APPLIED PHARMACOLOGY💊 (11 decks)

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