Iv fluids and problems of FVE etc Flashcards
Conditions leading to fluid loss and assoc symptoms
- BLEEDING-tachycardia and HoTN
- BOWEL OBSTRUCTION-reduced perspiration and mucous secretions
- DIARRHEA-reduced urine output (oliguria)
- FEVER-dry skin and mucous membranes
- VOMITING-reduced lacrimal and salivary secretions
crystalloids
- Fluids given by IV injection that supply water and sodium to maintain the osmotic gradient between extra and intravascular compartments.
- Crystalloids= a substance in a solution that diffuses through a semipermeable membrane
what type of fluid should be used to expand plasma volume
o Because they work by osmosis, hypertonic saline (3% sodium chloride) is more efficient than normal saline (0.9% sodium chloride) for expanding the plasma volume (PV)
do crystalloids contain proteins
no
should crystalloids or colloids be used to treat hypovolemic shock and why
o Compared w distribution of colloids, crystalloids are distributed faster into the interstitial and intracellular compartments making crystalloids better for treating dehydration than for expanding the PV alone eg in hypovolemic shock
indications for use of crystalloids
Indications
• Promote urine flow
• Used to compensate for insensible fluid loss, replace fluids when there are body fluid deficits and manage specific fluid and electrolyte disturbances
• Indications:
acute liver failure
• Acute nephrosis
• Adult resp distress syndrome
• Burns
• Cardiopulmonary bypass
• Hypoproteinemia
• Reduction of the risk of DVT
• Kidey dialysis
• Shock
death occurs when ___% of body water is lost
• Death often occurs when 20-25% of the total body water is lost
wheres water lost from initially during dehydration
• During initial dehydration water is lost first from extracellular compartments
t or f: crystalloids are contraindicated in hyponatremia and hypochloremia
F hyper is whn they shouldnt be used
contraindications fro cystalloids
Contraindications:
• Allergy
• Hyervolemia
• Hypernatremia, hyperchloremia
how would crystalloids affect acidosis or alkalosis
• Lg volumes are required for crystalloids to be effective which may worsen acidosis or alkalosis
adverse effects of crystalloids
Adverse effects
• Because they don’t contain lg particles they don’t stay within the bood vessels and can leak out of the plasma into the tissues and cells
• Results in peripheral edema and pulmonary edema
• Crystalloids also reduce the COP by diluting the proteins in plasma
• May result in dec oxygen tension as theyve reduced the RBC conc
• Lg volumes are required for crystalloids to be effective which may worsen acidosis or alkalosis
• Short lived effects
NaCl or what % is physiologically normal
0.9%
how do colloids work
Mechanism of action and drug effects
• Sometimes called plasma expanders
• Naturally occurring (albumin, dextran or starches, gelatine)
• Usually contain combo of both small and lg particles
• The small particles are elim quickly and promote dieresis but the lg ones maint plasma volume
how long can colloids maintain COP
• Can maintain COP for several hours (d/t lg particles)
colloids or crystalloids which is more likely to cause -bleeding -edema -lt plasma volume expansion -st PV expansion
- Colloids are superior to crystalloids in their ability to expand the plasma volume
- Crystalloids are less likely to promote bleeding
- Crystalloids are more likely t cause edema because fo the larger volumes needed to achieve the desired clinical effect
- Crystalloids are better than colloids for short term plasma volume expansion
colloid adverse effects
Adverse effects • Relatively safe • No )2 arrying capacity • Contain no clotting factors • Dilute • Impair platelet func • Rarely dextran therapy causes anaphylaxis or kidney failure
crystalloids or colloids which is more compatible with other drugs
colloids. are used as medium for drug delivery
mgmt of bleeding Less than or equal to 20% use
crystalloids
• mgmt of bleeding 20-50% low loss
NONPROTEIN PLASMA EXPANDERS-DEXTRAN AND HETASTARCH
mgmt of bleeding • Greater than 50% slow loss or 20% acute-
WHOLE BLOOD OR PACKED RBC AND OR FRESH FROZEN PLASMA AND PLASMA PROTEIN PPF AND FFP
mgmt of bleeding
• Greater than or equal to 80% lost
- Greater than or equal to 80% lost=AS below BUT FOR EVERY 5 UNITS OF BLOOD GIVEN, ADMINISTER 1-2 UNITS FRESH FROZEN PLASMA AND 1-2 UNITS OF PLATELETS TO PREVENT HEMODILUTION OF CLOTTING FACTORS AND BLEEDING
- Greater than 50% slow loss or 20% acute-WHOLE BLOOD OR PACKED RBC AND OR FRESH FROZEN PLASMA AND PLASMA PROTEIN PPF AND FFP
what type of drugs are blood products
• Biological drugs
MOA blood products
- Inc COP and blood volume
* They pull fluid from the extravascular space to the intravascular space therefore theyre plasma expanders
types of blood products and their indications
- Cryoprecipitate ad plasma protein fraction-to manage acute bleeding >50% blood loss slowly or 20% acutely
- Fresh frozen plsma-to inc clotting factor level in pts w demonstrated deficiency
- Packed RBC-to inc )2 carrying capacity in pts w anemia, in pts w substantial Hb deficits, and in pts whove lost up to 25% of their total blood volume
- Whole blood-same as packed RBCs except that whole blood is more beneficial in cases of extreme (>25%) loss of blood volume, since whole blood contains plasma it also contains more plasma proteins
disadvantages of packed RBCs
• Disadvantages=high cost, limited shelf life, fluctuating availability, risk for virus transmission, allergic rxns and bleeding abn
