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2. It is an effective, and efficient method of
supplying fluid directly into intravenous fluid
compartment producing rapid effect ,with
availability of injecting large volume
of fluid more than any other method of
administration

6.  Water provides a medium for transporting nutrients to
cells and wastes from cells and for transporting substances
such as hormones, enzymes, blood platelets, and red and
white blood cells
 Water facilitates cellular metabolism and proper cellular
chemical functioning
 Water acts as a solvent for electrolytes and
nonelectrolytes
Helps maintain normal body temperature
Facilitates digestion and promotes elimination
Acts as a tissue lubricant

7. Provide transportation of
nutrients to cell
Carry waste product away
from the cell
Provide an environment for
chemical reaction

8.  Body fluid composition is water and dissolved
substance consisting of solute and
electrolytes
 Rule of 60-40-20
 60 %of the body weight is water
 40% body weight is intracellular fluid (ICF)
 20% of body weight in extracellular fluid
(ECF)

9.  TBW 60% ( 42 liters )
 ICF 2/3 25 liters
 ECF 1/3 17 liters
ECF
1. Interstitial fluid (ECF 75%) 11liter
2. Intravascular fluids (ECF 20%) 5 liters
3. TRANSCELLULAR FLUID: Lymph ,synovial,
intestinal, CSF, sweat, urine, pleural,
peritoneal, pericardial, intraocular GI
(5% ECF)1 Liters

10. BODY FAT
 Because fat cells contain little water and
lean tissue is rich in water, the more obese
the person, the smaller the percentage of
total body water compared with body
weight.
 This is also true between sexes because
females tend to have proportionally more
body fat than males.
 There is also an increase in fat cells in
older people

11. Children 70%
Adult male 60%
Adult female 50%
Old age 45%

12.  Diffusion
 Filtration
 Osmosis: The diffusion of solvent into a region
where there is a higher concentration of solute is
termed as osmosis
 Osmotic pressure: if two solution are separated
by a semi permeable membrane, solvent particle
tend to move in the direction of higher solute
concentration. If a pressure is applied to the
compartment of higher solute concentration
which oppose this movement, that pressure is
equal to osmotic pressure

13.  Number of solute particles per kg solvents
 Therefore osmolality is define the number of
osmole of a solute dissolved/kilogram
solvents

14.  Number of solute particles per liter of
solution ,since its difficult to measure
kilogram of water in a solution which is
required to determine osmolality
 As volume of solvent can change with
temperature need to be specified for
measurement

15.  Collide are larger gelatinous molecules with
molecular weight greater than 10000 Da
 Example include plasma protein like albumen
and other synthetic collides like gelofusine.
 These molecules are unable to cross
biological cell membrane due to their size
and hence exert their own pressure on the
membrane called collide osmotic pressure or
oncotic pressure

16.  The effect of fluid on cellular volume is
known is tonicity
 The tonicity of a standard IV solution is
define by their electrolytes concentration
(cations)if the sum of sodium and potassium
and other ions is more than 150 mEq/L the
solution is considered is hypertonic if less
than 150 mEq/L is hypotonic
 Isotonic: same solute concentration as blood
0.9% NS

18. Indications
 Coma, anaesthesia, Severe vomiting and
diarrhoea,
 Dehydration and shock
 Hypoglycemia
 Vehicle for – antibiotics, chemotherapy
agents
 TPN
 Critical problems – anaphylaxis, status
asthmaticus or epilepticus, cardiac arrest ,
forced diuresis in drug overdose, poisoning

19. Accurate , controlled and predictable way of
administration
 Immediate response due to direct infusion
 Prompt correction of serous fluid and
electrolyte disturbances

20.  More expensive, need asepsis, and under
skilled supervision
 Improper selection of type, volume , rate
and technique can lead to serious problems
Contra indications
 Avoided if patient can take oral fluids
 CHF, pulmonary edema

21. Local : hematoma , infusion phlebitis
 systemic :
• Large volume can lead to circulatory
overload
• Rigors, air embolism
• Septicemia
 others – fluid contamination, mixing of
incompatible drugs

22. 1. Maintenance fluids : replaces insensible fluid
losses
5 % dextrose, dextrose with 0.45 % NS
2. Replacement fluids : correct body fluid deficit
gastric drainage, vomiting,diarrhoea, infection
, trauma, burns
3. Special fluids :
 Hypoglycemia – 25 % dextrose
 Hypokalemia – inj Kcl
 Metabolic acidosis – inj soda bicarb
 Electrolytes and collides

23. Composition : Glucose 50 gms
Pharmacological basis :
Corrects dehydration and supplies energy( 170Kcal/L)
Indications :
• Prevention and treatment of dehydration
• Pre and post op fluid replacement
• IV administration of various drugs
• Prevention of ketosis in starvation, vomiting, diarrhea
• Adequate glucose infusion protects liver against toxic
substances
• Correction of hypernatremia

24. Contra indications
 Cerebral edema, neuro surgical procedures
 Acute ischaemic stroke
 Hypovolemic shock
 Hyponatremia , water intoxication
 Same iv line blood transfusion – hemolysis ,
clumping occurs
 Uncontrolled DM , severe hyperglycemia
Rate of adminstration – 0.5 gm/kgBW/hr or
666ml/hr5 % D or 333ml/hr 10%D

25.  Composition : Na 154 mEq, Cl 154 meq
 Pharmacological basis : provide major EC
electrolytes..
corrects both water and electrolyte deficit.
increase the iv volume substantially
Contra indications
 Avoid in pre eclamptic patients, CHF, renal disease
and cirrhosis
 Dehydration with severe hypokalemia – deficit of IC
potassium
 Large volume may lead to hyperchloremic acidosis.

26.  Water and salt depletion – diarrhoea,
vomiting, excessive diuresis
 Hypovolemic shock
 Alkalosis with dehydration
 Severe salt depletion and hyponatremia
 Initial fluid therapy in DKA
 Hypercalcemia
 Fluid challenge in prerenal ARF
 Irrigation – washing of body fluids
 Vehicle for certain drugs

27. Composition : Na Cl – 154 mEq, glucose 50 gm
Pharmacological basis :
• Supply major EC electrolytes, energy and
fluid to correct dehydration
Indications :
• Conditions with salt depletion ,hypovolemia
• Correction of vomiting or NGT aspiration
induced alkalosis and hypochloremia
Contra indications :
• cardiac, hepatic or renal failure
• Severe hypovolemic shock

28. Composition – Na, k , cl, lactate , ca
each 100 ml – sodium lactate 320 mg, Nacl -
600mg, kcl-40mg, calcium chloride 27 mg
Pharmacological basis :
• Most physiological fluid , rapidly expand s iv
volume..
• Lactate metabolised in liver to bicarbonate
providing buffering capacity
• Acetate instead of lactate advantageous in
severe shock.

29. • Correction in severe hypovolemia
• Replacing fluid in post op patients, burns
• Diarrhoea induced hypokalemic metabolic
acidosis
• Fluid of choice in diarrhoea induced
dehydration in paediatrics
• DKA , provides water, correct metabolic
acidosis and supplies potassium
• Maintaining normal ECF fluid and electrolyte
balance

30. Liver disease, severe hypoxia
• Severe CHF , lactic acidosis takes place
• Addison’s disease
• Vomiting or NGT induced alkalosis
• Simultaneous infusion of RL and blood
• Certain drugs – amphotericin, thiopental,
ampicillin, doxycycline

31. Colloids : large molecular wt substances that largely remains in
the intravascular compartment thereby generating oncotic
pressure
3 times more potent
1 ml blood loss = 1ml colloid = 3ml crystalloids

32. Type of fluid Effective plasma
volume
expansion/100ml
duration
5% albumin 70 – 130 ml 16 hrs
25% albumin 400 – 500 ml 16 hrs
6% hetastarch 100 – 130 ml 24 hrs
10% pentastarch 150 ml 8 hrs
10% dextran 40 100 – 150 ml 6 hrs
6% dextran 70 80 ml 12 hrs

33.  Sterile, pyrogen free 3.5 % solution
 Polymer of degraded gelatin with electrolytes
 2 types
• Succinylated gelatin (modified fluid gelatin)
• Urea cross linked gelatin ( polygeline)
Composition : Na Cl 145 mEq, Ca 12.5 mEq,
potassium 5.1 mEq
Indications :
• Rapid plasma volume expansion in hypovolemia
• Volume pre loading in regional anesthesia
• Priming of heart lung machines

34. • Does not interfere with coagulation, blood
grouping
• Remains in blood for 4 to 5 hrs
• Infusion of 1000ml expands plasma volume
by 300 to 350 ml
Side effects :
• Hypersensitivity reaction
• Should not be mixed with citrated blood

35. Bleeding disorders , CHF
• Impaired renal function

36. Electrolytes

37.  Electrolytes are charged particles (ions) that are
dissolved in body fluids.
 Electrolytes (Dissolved Ions)
Major Positive Ions (Cations)
Sodium ion, Na +
Potassium ion, K +
Calcium ion, Ca 2+
Magnesiwn ion, Mg 2

38.  Major Negative Ions (Anions)
 Chloride ion, 0 -
 Bicarbonate ion, HCO 3-
 Phosphate ions,
 HPO 2

40. • Controls and regulates volume of body fluids
• Its concentration is the major determinant of ECF volume
• Is the chief electrolyte of ECF
• Influence ICF Volume
 •Participates in the generation and transmission of nerve impulses
• Is an essential electrolyte in the sodium-potassium pump
• Eliminated primarily by the kidneys, smaller in feces and perspiration
• Salt intake affects sodium concentrations
• Sodium is conserved through reabsorption in the kidneys, a process
stimulated by aldosterone
• Normal value: 135-145 mEq/L

41. • Major cation of the ICF. Chief regulator of cellular enzyme activity
and cellular water content
The more K, the less Na. The less K, the more Na
Plays a vital role in such processes such as transmission of electrical
impulses, particularly in nerve, heart, skeletal, intestinal and lung tissue;
CHON and CHO metabolism; and cellular building; and maintenance of
cellular metabolism and excitation
Assists in regulation of acid-base balance by cellular exchange with H
Sources: bananas, peaches, kiwi, figs, dates, apricots, oranges,
prunes, melons, raisins, broccoli, and potatoes, meat, dairy products
Excreted primarily by the kidneys. No effective conserving mechanism
Conserved by sodium pump and kidneys when levels are low
Aldosterone triggers K excretion in urine
• Normal value: 3.5 – 5 mEq/L

42. • Most abundant electrolyte in the body. 99% in bones and teeth
Close link between calcium and phosphorus. High PO4, Low Ca
Necessary for nerve impulse transmission and blood clotting
and is also a catalyst for muscle contraction and other
cellular activities
Needed for Vitamin B12 absorption and use
Necessary for strong bones and teeth and thickness and
strength of cell membranes
Higher for children and pregnant and lactating women
according to body weight, older people, esp. post-menopausal
Found in milk, cheese, and dried beans; some in meat and
vegetables
Use is stimulated by Vitamin D. Excreted in urine, feces, bile,
digestive secretions, and perspiration
• Normal value 8.5 – 10.5 mg/dl

43. • Mostly found within body cells: heart, bone, nerve, and muscle
tissues
• Second most important cation in the ICF, 2nd to K+
• Functions: Metabolism of CHO and CHON, protein and DNA
synthesis, DNA and RNA transcription, and translation of RNA,
maintains normal intracellular levels of potassium, helps
maintain electric activity in nervous tissue membranes and
muscle membranes
• children require larger amounts
• Sources: vegetables, nuts, fish, whole grains, peas, and beans
• Absorbed in the intestines and excreted by the kidneys
• Plasma concentrations of magnesium range from 1.5 – 2.5
mEq/L, with about one third of that amount bound to plasma
proteins