L12: Fluid Therapy Flashcards
1
Q
MindMap of Fluid Therapy
A
2
Q
Body water
A
3
Q
Characters of Fluid movement between the intravascular & interstitial spaces
A
4
Q
ICF about …… of TBW & ECF about ….. of TBW.
A
- 55-75%
- 25-45%
Intravascular (1) : Extravascular (3)
5
Q
Concentration of electrolytes in body
A
6
Q
what ion represents a Principal component of ECF?
A
Na
7
Q
Role of Na in fluid balance
A
Responsible for much of extracellular fluid osmolality.
8
Q
what ion represents a Principal component of ICF?
A
K
9
Q
Role of K in action potential
A
key role in the maintenance of transmembrane potentials.
10
Q
Classification of IV Fluids
A
11
Q
Compare between Crystalloids & Colloids in terms of:
- Composition
- Characters
- Importance
A
12
Q
Mindmap of crystalloids & Colloids
A
13
Q
Def of Crystalloids
A
- Electrolyte solutions with small molecules that can diffuse freely from intravascular to interstitial fluid compartments.
14
Q
what is a principal component of Crystalloids?
A
sodium chloride
- Sodium is principal determinant of extracellular volume, and is distributed uniformly in the extracellular fluid.
15
Q
Volume effect of Crystalloids
A
16
Q
Classification of Crystalloids according to tonicity
A
17
Q
Classification of Crystalloids according to ionization
A
18
Q
General Characters of Crystalloids
A
- Contains water & electrolytes.
- Non-ionic solutions expand all the compartments (Intracellular & extracellular space).
Sodium cannot gain access into the intracellular space. - Hence all sodium will remain in the extracellular space thus expanding
19
Q
what is One of the most commonly administered crystalloids?
A
Normal Saline
20
Q
History of Normal Saline
A
21
Q
Uses of normal saline across the history
A
22
Q
what are names of Normal Saline?
A
0.9% saline
= Normal saline = Physiological saline = Isotonic saline
23
Q
why are none of the previous names accurate?
A
- The concentration of a one-normal (1 N) NaCL solution is 58 grams per liter How? Molecular weights of sodium + molecular weights of chloride = 23 + 35 = 58
- While 0.9% NaCL contains only 9 grams of NaCL per liter.
23
Q
Composition of Normal Saline
A
24
Pharmacological basis of **Normal Saline**
- Provide major extracellular electrolytes.
- Corrects both water & electrolyte deficit.
- Increase intravascular volume substantially.
25
Volume effects of **Normal Saline**
25
what are disadvantages of **Normal Saline**?
26
Indications of **Normal Saline**
26
Limitations of **Normal Saline**
26
why is **Normal Saline** used in hypovolemic shock?
- Distributed in ECS expanding the intravascular volume.
- Ideal fluid to Increase blood pressure.
27
History of **Ringer Fluids**
28
Composition of **Ringer Lactate**
28
why is **Ringer Lactate** the most physiological fluid? and what are the advantages of this?
- As the electrolyte content is similar to that of plasma, So Larger volumes can be infused without the risk of electrolyte imbalance.
28
Pharmacological basis of **Ringer Lactate**
**The most physiological fluid:**
- As the electrolyte content is similar to that of plasma.
- So Larger volumes can be infused without the risk of electrolyte imbalance.
**Effective in treatment of hypovolemia:**
- Due to high Nat content (130mEq/L) -> Rapidly expands intravascular volume.
**Useful in correction of metabolic acidosis:**
- As sodium Lactate in RL is metabolized to Bicarbonate in the liver.
29
what is the most physiological fluid?
Ringer's Lactate
30
Advantages of **Ringer Lactate**
Lack of significant effect on acid base balance.
31
why isn't it recommended to give **Ringer Lactate** with Stored blood?
lonized calcium "in ringer's lactate" Binds to citrated anticoagulant "in stored blood" and Promote formation of clots.
31
Disadvantages of **Ringer Lactate**
32
why isn't **Ringer Lactate** recommended in critically ill patients with impaired lactate clearence?
"due to circulatory shock or hepatic insufficiency" ----> Can 11 serum lactate levels.
33
Indications of **Ringer Lactate**
34
what is the fluid of choice in Diarrhea-induced dehydration in pediatric patients?
Ringer's lactate
34
Limitations of **Ringer Lactate**
35
why is **Ringer Lactate** CI in vomiting or continuous nasogastric aspiration?
Hypovolemia is associated with metabolic alkalosis, As RL provides HCO3 - Worsens alkalosis.
36
what drugs should you avoid giving **Ringer's lactate** with? and why shouldn't we?
* Amphotericin
* Ampicillin
* Thiopental
* Doxycycline
**Calcium binds with these drugs and #I bioavailability & efficiency.**
37
Types of **Dextrose Solutions**
38
Effects of **Dextrose Solutions**
* Protein sparing effects.
* Volume effect.
* Lactate production.
* Effect of hyperglycemia.
39
Composition of **D5W**
- Glucose 50 gm/L.
- Free water.
40
Volume effects of **D5W**
41
Pharmacological basis of **D5W**
- Corrects Dehydration.
- Supplies Energy (70kca/L).
- Administered safely at the rate of 0.5 gm/kg/hr without causing glycosuria.
42
Metabolism of **D5W**
43
Indicatations of **D5W**
44
Limitations of **D5W**
45
Why is **D5W** CI in neurological Procedures?
aggravate Cerebral edema & 1t ICT.
46
D5W in acute Ischemic stroke
47
why is **D5W** CI in hypovolemic Shock?
- Poor expansion of intracellular volume.
- Faster rate of infusion ----> osmotic diures. --->
© Worsens shock
© False impress of the hydration status decreases Fluid replacement.
48
what does **D5W** cause in cases of hyperinfusion?
49
Blood & dextrose solutions should not be administered in same IV line, why?
Hemolysis & clumping seen due to hypotonicity of the solution.
50
Composition of **D10W**
1 liter of 10%D has 100 gm glucose
51
Composition of **D25W**
1 liter of 25%D has 250 gm glucose
52
Pharmacological basis of **D10W & D25W**
53
Indications of **D10W & D25W**
54
Limitations of **D10W & D25W**
55
why are **D10W & D25W** indicated in liver diseases?
given as first drip, it inhibits glycogenolysis & gluconeogenesis
56
Composition of **DNS**
57
Volume effects of **DNS**
58
If glucose utilization is impaired as is common in critically ill patients), large-volume infusion of D5W can result in .......
cellular dehydration.
59
Pharmacological basis of **DNS**
60
Indications of **DNS**
61
what is **DNS** not the ideal fluid in salt depletion & hypovolemia?
- Faster rate of infusion ---> osmotic diuresis ---> Worsens shock
- False impress of the hydration status - Il Fluid replacement.
62
Limitations of **DNS**
63
Composition of **D1/2NS**
64
Pharamacological Basis of **D1/2NS**
- Contains 50% salt as compared to DNS & NS
- Used when there is need for: Calorie, More water, Less salt.
65
Indications of **D1/2NS**
66
Limitations of **D1/2NS**
67
what are examples of **Hyperosmolar Fluids**?
- Mannitol
- Hypertonic Saline
68
Def of **Mannitol**
Osmotic diuretic that is metabolically inert in human.
69
Pharmacological basis of **Mannitol**
70
Complications of **Mannitol**
- Rebound edema.
- Renal failure.
- Dehydration: due to osmotic diuresis.
71
Limitations of **Mannitol**
- Anuria due to severe renal disease.
- Cannot be used in patients with hypotension.
- Severe pulmonary congestion or frank pulmonary edema.
- Active intracranial bleeding except during craniotomy.
- Severe dehydration.
- Progressive renal damage or dysfunction after institution of mannitol therapy, including increasing oliguria & azotemia.
72
Types & Composition of **Hypertonic saline**
73
Pharamcological Properties of **Hypertonic saline**
- The hypertonic nature of these solutions draws water out of the intracellular compartment into the extracellular compartment
74
Indications of **Hypertonic saline**
75
definition of **Colloids**
A saline fluid with large solute molecules that do not readily pass from plasma to interstitial fluid.
76
History of **Colloids**
- The term colloid is derived from Greek word "Glue"
- These solutions are also called suspensions.
77
Characters of **Colloids**
78
General Characteristcs of **Colloids**
79
Capillary Fluid Exchange
80
Crysatlloid fluid effect on COP
Decrease The plasma COP (dilutional effect): Which favors the movement of these fluids out of the bloodstream.
81
Colloid fluid effect on COP
82
Colloid fluid is about ....... more effective in expanding the plasma volume than the crystalloid fluid.
3 times
83
Characteristics of IV colloids fluids per 100 ml infusion
84
Classification of colloids
85
Formation of **Albumin**
Albumin is a versatile plasma protein, synthesized only in the liver.
86
Half-Life of Albumin
Approximately 20 days.
87
Types of **Albumin**
- 5% albumin
- 25% albumin
88
Compare between 5% albumin & 25% in terms of:
- Concentration
- COP
- Volume Effect
- Rate
89
Importance of **Albumin**
* Principal determinant of plasma colloid osmotic pressure COP 75-80 % of the oncotic pressure".
* Principal transport protein in blood.
* Has significant antioxidant activity.
* Helps maintain the fluidity of blood by inhibiting platelet aggregation.
90
Indications of **Albumin**
91
Limitations of **Hyperoncotic (25%) albumin**
- Should not be used for volume resuscitation in patients with blood loss, Because it does not replace lost volume, but instead shifts fluid from one compartment to another.
- Has been associated with an If risk of renal injury & death in patients with circulatory shock.
92
Limitations of 5% albumin
Safe to use as a resuscitation fluid...
* Except possibly in traumatic head injury
93
Limitations commom in both **Hyperoncotic (25%) albumin** & **5% albumin**
- Fast infusion > Rapidly If circulatory volume ..* vascular overload & pulmonary edema.
- Dehydrated patient may require additional fluids along with albumin.
- Contraindicated in severe anemia & cardiac failure.
- Should not be used as parenteral nutrition.
94
Elimination of **HES**
**Metabolism:**
- Hydrolysis by amylase enzymes in the bloodstream, which cleave the parent molecule until it is small enough to be cleared.
**Excretion:**
- Cleared by the kidneys. Cleared by the kidneys.
95
Nature of **HES**
- Chemically modified polysaccharide.
- Derivatives of amylopectin "which is a highly branched compound of starch".
- Composed of long chains of branched glucose polymers, Substituted periodically by hydroxyl radicals (OH) "which resist enzymatic degradation"
96
Disadvantages of **Albumin**
**Cost effectiveness:**
- Albumin is expensive as compared to synthetic colloids.
**Cause volume overload:**
- In septic shock, the release of inflammatory mediators has been implicated in If the 'leakiness' of the vascular endothelium.
- So The administration of exogenous albumin may compound the problem by adding to the interstitial edema.
97
Phsyiochemical properties of **HES**
98
Advantages of **HES**
**Cost effectiveness**
- HES is less expensive as compared to albumin & is associated with a comparable volume of expansion.
**Maximum allowable volume:**
- Maximum volume which can be transfused of "medium weight HES (130 kDa) with medium degree of substitution (0.4)" is greater as compared to other synthetic colloids like dextrans.
- decrease The estimated incidence of anaphylactic reactions compared to other colloids.
99
Indications of **HES**
- Stabilization of systemic hemodynamics.
- Anti-inflammatory properties.
- HES has been shown to preserve intestinal microvascular perfusion in endotoxemia, Due to their anti-inflammatory properties.
100
Disadvantages of **HES**
101
How does **HES** affect coagulation?
By decreasing The following:
- Fibrinogen.
- Platelet aggregation.
- WWF (Von Willebrand Factor).
- Factor Vill.
leading to
- Increasing PTT, PT & bleeding time.
102
**HES** & Increasing serum amaylase Concentration
- During use.
- & 3-5 days after discontinuation.
103
HES products with medium to high MW are associated with ......
- Oliguria.
- Increase Creatinine.
- Acute Kidney Injury
**In critically Ill patients with preexisting renal impairment**
