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Basics of fluid therapy
- 1. Nehal M. Ramadan, MSc. PhD. Lecturer of clinical pharmacology Faculty of medicine, Mansoura university, Egypt
- 2. Intravenous fluid therapy Intravenous (iv) fluid therapy is the administration of fluids directly into the general circulation through venipuncture. Whenever possible, fluids should be provided orally, as iv fluid therapy exposes patients to risks such as fluid overload (giving too much fluid). iv fluid therapy is required when: oral intake is insufficient (e.g. when a patient is “nil by mouth” or has reduced absorption) to replace large fluid losses or when very rapid replacement is necessary.
- 3. Fluid Losses can occur from: The GIT tract vomiting or diarrhea The urinary tract polyuria Blood loss trauma or surgery. Fever or severe burns increased insensible losses fluid loss from skin and resp. tract). Inflammatory conditions (e.g. sepsis) VD & “leakage” of vascular endothelial walls loss of circulating intravascular fluids accumulate into interstitial tissue & serous spaces (the peritoneal or pleural cavities).
- 4. Indications of iv fluid therapy (Why to give iv fluids) Correct hypovolemia restore an effective circulating intravascular volume and vital organ perfusion ◦ Maintain COP ◦ Optimize O2 delivery to tissues. ◦ Maintain urine output. Replace electrolytes & correct acid-base imbalance. Administer blood and blood products Administer medication Provide parenteral nutrition
- 7. Water movement between the plasma and interstitial spaces ICF Interstitial ECF Capillary Membrane Capillary membrane is freely permeable to water and electrolytes but not to large molecules such as proteins (albumin). The albumin on the plasma side gives rise to a colloid osmotic pressure gradient H2O H2O
- 8. Water movement between the interstitial and intracellular spaces ICF Interstitial Cell Membrane H2O H2O Cell membrane is freely permeable to H20 but not Na and K move via pumps across this membrane to maintain a gradient! K+ Na+
- 9. Solutions of water containing ions (such as Na, K, and Cl) or sugars (such as glucose) or both. Crystalloids Large molecular weight substances typically dissolved in crystalloid solutions such as 0.9% saline. They can be classified into two major groups: • The semisynthetic (hydroxyethyl starches, gelatins, and dextrans) • Plasma derivatives (such as albumin) Colloids Types of iv fluids
- 10. Isotonic solutions Has the same solute conc. as ICF Ex. 0.9% sodium chloride sol. (normal saline) or Lactated ringer sol. or 5% glucose sol. Hypotonic solutions Has lower solute conc. compared to ICF Ex. 0.45% sodium chloride sol. or 2.5% glucose sol. Hypertonic solutions Has higher solute conc. compared to ICF Ex. 3% sodium chloride sol. or 50% glucose sol. Crystalloids (types)
- 11. Effect of different types of crystalloids on fluid movement and cell size
- 12. ICF Interstitial ECF Capillary Membrane Cell Membrane When replacing blood with isotonic Sol., around x4 the volume of blood loss is needed as only 1/4 of the infusion volume remains in plasma.
- 13. Colloids Colloids do not easily cross the capillary membrane persist intravascularly explains their extensive use in rapid management of hypovolemia). ICF Interstitial ECF Capillary Membrane Cell Membrane Compared to crystalloids, colloids are expensive and are associated with adverse reactions such as renal failure, coagulation disturbances, and anaphylaxis. Currently, there is no evidence to support the use of colloids for volume resuscitation, and their use in critically ill patients is likely to be harmful.
- 14. Summary Colloids are retained in plasma. 0.9% saline and balanced salt sol. are distributed in ECF only (plasma and interstitial fluid). Glucose sol. are distributed proportionally into ICF.