Renal Physiology (VI) - IV fluids (Applied physiology)

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by dr Mohammed Abel Gawad (drgawad@gmail.com): Nephrology Specialist at Kidney & Urology Center - Alexandria - Egypt. website: www.nephrotube.blogspot.com

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Renal Physiology (VI) - IV fluids (Applied physiology)

  1. 1. 1RENAL PHYSIOLOGY (VI) MINTRAVENOUS FLUIDS (APPLIED PHYSIOLOGY) Mohammed Abdel Gawad
  2. 2. OBJECTIVES2  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  3. 3. OBJECTIVES3  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  4. 4. Total body water Compartments4
  5. 5. Osmolality is the number of particles (mmol) contained in one liter of water, so measured in mmol/L. i.e. it is the concentration by number
  6. 6. Water, Electrolytes & Non-Electrolytes Distribution (1)6
  7. 7. Water, Electrolytes & Non-Electrolytes Distribution (2)7
  8. 8. Osmolality of all three compartments8  Osmolality of all three compartments is the same, because water is able to move freely among all three compartments
  9. 9. OBJECTIVES9  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  10. 10. Intravenous fluids forms10
  11. 11. Applied physiology of IV fluid11 Answer this points in every IV fluid type: 1- Content? 2- Tonicity? 3- Distribution, water where are u? Use in volume replacement?
  12. 12. Tonicity12 Isotonic Solution Cells normal shape, no loss or gain of water. Hypertonic Solution Cells lose water and shrink. Hypotonic Solution Cells swell rapidly as water rushes into them.
  13. 13. Osmolality is the number of particles (mmol) contained in one liter of water, so measured in mmol/L. i.e. it is the concentration by number
  14. 14. OBJECTIVES14  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  15. 15. Dextrose solutions: Content & Tonicity15  Glucose content ?  Tonicity ?
  16. 16. Dextrose solutions: Distribution16
  17. 17. Dextrose solutions: Distribution17  Dextrose solutions are a poor choice for intravascular volume replacement
  18. 18. Dextrose solutions: Deliver energy & water to the body.18  Since 1 gram of dextrose (glucose) has 3.5 Cal, one liter of D5W (50 gm glucose) has 175 Cal  D5W is used instead of pure water because D5W is isotonic to plasma. (If pure water were given, the water would be osmotically drawn into red blood cells, causing them to burst).
  19. 19. OBJECTIVES19  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  20. 20. Saline solutions: Content & Tonicity20  NaCl content ?  Tonicity ?
  21. 21. Saline solutions: Distribution: Isotonic Saline 0.9%21  Used for treatment of dehydration & hypovolemia
  22. 22. Saline solutions: Distribution: Hypotonic Saline 0.45%22  0.45% NaCl is commonly combined with D5W and used as a maintenance IV.  A maintenance IV is meant to replace water and solute losses and provide some calories to patients who are not eating.
  23. 23. Saline solutions: Distribution: Hypertonic Saline 3%23  The NaCl adds 718 milliequivalents (359 mEq of Na and 359 mEq of Cl) to the extracellular compartment which draws in 2,500 mL of water from the intracellular compartment.
  24. 24. OBJECTIVES24  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  25. 25. Lactated Ringer’s: Content & Tonicity25  Content ?  Tonicity ?
  26. 26. Lactated Ringer’s: Distribution26 1 liter 750 ml 250 ml
  27. 27. Lactated Ringer’s: Caution27  Lactated Ringer’s is contraindicated in patients with lactic acidosis, lactate is unable to be converted to bicarbonate in this disorder.  Lactated Ringer’s should also be avoided in patients with metabolic alkalosis.
  28. 28. OBJECTIVES28  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  29. 29. Plasma expanders29 human blood products (e.g., plasma, packed red blood cells, albumin) large molecules which do not pass through the capillary walls (e.g., hetastarch, polygelatins). expensive and can cause allergic reactions
  30. 30. IV solutions: Distribution30
  31. 31. OBJECTIVES31  Body water compartments  Electrolytes & Non-Electrolytes distribution  IV fluids forms  Dextrose  Saline  Lactated Ringer’s  Plasma expanders  IV fluids – Clinical Correlation
  32. 32. IV solutions: Clinical correlation: Caloric Expenditure Method32  Maintenance IV fluids are typically used to supplement daily water and electrolyte losses in patients who are unable to eat or drink. To administer the proper amount of IVF, daily fluid loss must be determined.  Caloric Expenditure Method done on 2 steps:  1- detect calories consumed/day.  2- detect amount of water & electrolytes that be suspect to be lost by these calories.
  33. 33. IV solutions: Clinical correlation: Caloric Expenditure Method33  1- detect calories consumed/day by:  a- Holiday-Segar method: (depend on weight)  b- Body surface area:
  34. 34. IV solutions: Clinical correlation: Caloric Expenditure Method34  2- detect amount of water & electrolytes that be suspect to be lost by these calories.  Special situations:
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  36. 36. 36 Gawad

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