1) The document discusses various intravenous fluid options including crystalloids like normal saline, Ringer's lactate, dextrose saline and colloids like albumin and dextran.
2) It provides the composition, indications, contraindications and precautions for each fluid. Daily fluid balance and electrolyte concentrations in body fluids are also reviewed.
3) Calculating plasma osmolality and basic principles of IV fluid therapy including advantages, disadvantages, classification and complications are summarized. Clinical examples of fluid depletion and specific treatment approaches are mentioned.
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Fluid and electrolyte balance in oral surgeryPunam Nagargoje
• ELECTROLYTE BALANCE
• Def: - concentration of individual electrolytes in the body fluid compartments is normal and remains relatively constant.
• Electrolytes are dissolved in body fluids
• Sodium predominant extracellular cation, and chloride is predominant extracellular anion. Bicarbonate also in extracellular spaces
• Electrolyte balance
• Na + (Sodium)
– 90 % of total ECF cations
– 136 -145 mEq / L
– Pairs with Cl- , HCO3- to neutralize charge
– Low in ICF
– Most important ion in regulating water balance
– Important in nerve and muscle function
• Electrolyte imbalances: Sodium
• Hypernatremia (high levels of sodium)
– Plasma Na+ > 145 mEq / L
– Due to ↑ Na + or ↓ water
– Water moves from ICF → ECF
– Cells dehydrate
• HYPERATREMIA
• Hypernatremia Due to:
– Hypertonic IV soln.
– Oversecretion of aldosterone
– Loss of pure water
• Long term sweating with chronic fever
• Respiratory infection → water vapor loss
• Diabetes – polyuria
– Insufficient intake of water .
• Clinical manifestations
of Hypernatremia
• Thirst
• Lethargy
• Neurological dysfunction due to dehydration of brain cells
• Decreased vascular volume
• TREATMENT OF HYPERNATREMIA:
• Lower serum Na+
– Isotonic salt-free IV fluid [5% dextrose]
– Oral solutions preferable
• Hyponatremia
• Overall decrease in Na+ in ECF
• Two types: depletional and dilutional
• Depletional Hyponatremia
Na+ loss:
– diuretics, chronic vomiting
– Chronic diarrhea
– Decreased aldosterone
– Decreased Na+ intake
• Clinical manifestations of Hyponatremia
• Neurological symptoms
– Lethargy, headache, confusion, apprehension, depressed reflexes, seizures and coma
• Muscle symptoms
– Cramps, weakness, fatigue
• Gastrointestinal symptoms
– Nausea, vomiting, abdominal cramps, and diarrhea
• Tx – limit water intake or
• discontinue medicines such as diuretics
• TREATMENT OF HYPONATREMIA
• Hyponatremia which develops quickly should be treated quickly & vice-versa
• Patients with severe hypoNa (<115) are at risk of neurological damage
• Too rapid correction causes CENTRAL PONTINE MYELINOLYSIS.
• Targeted rate of correction: 0.5-1.0 mEq/L/hour
• Raise plasma Na by <10-12 mEq/L on first day
• Correction @ rate >25mEq/L places at high risk for central pontine myelinolysis
• Hypokalemia
• Normal serum k+ conc is 3.5 to 5.0 mEq/l
• Serum K+ < 3.5 mEq /L
• Beware if diabetic
– Insulin gets K+ into cell
– Ketoacidosis – H+ replaces K+, which is lost in urine
• β – adrenergic drugs or epinephrine
• Causes of Hypokalemia
• Decreased intake of K+
• Increased K+ loss
– Chronic diuretics
– Acid/base imbalance
– Trauma and stress
– Increased aldosterone
– Redistribution between ICF and ECF
• Treatment of hypokalamia
• Metabolic acidosis increases serum K+ levels & vice versa
• Post-op patients on fluid therapy should receive approx 60mEq/day to prevent hypokalemia
• 1mEq/L fall in serum K+= 200-400 mEq total body K+ deficit
• Failure to ↑ Sr. K+ even after sufficient correction should
general presentation and management of Fluid & Electrolyte.pptxNatnael21
Discussion about physiology of fluid balance in human and clinical presentation and general management principles of major electrolyte abnormality like hypernatremia hyponatremia hyperkalemia and hypokalemia
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
6. Third Space
• Acute sequestration in a body
compartment that is not in equilibrium
with ECF
• Examples:
– Intestinal obstruction
– Severe pancreatitis
– Peritonitis
– Major venous obstruction
– Capillary leak syndrome
– Burns
7. Daily Fluid Balance
Insensible fluid loss = 500 ml through skin
= 400 ml through lungs
= 100 ml through stool
Insensible fluid input = 300 ml due to Oxidation
Daily insensible fluid loss = 1000 ml – 300 ml
= 700 ml
8. Electrolyte concentration of body fluids (mEq/L)
Electrolytes ECF ICF
Sodium
Potassium
Chloride
Bicarbonate
Calcium
Magnesium
Phosphate and Sulphate
142.00
4.30
104.00
24.00
5.00
3.00
8.00
10.00
150.00
2.00
6.00
0.01
40.00
150.00
ECF ICF
Major Cation Sodium Potassium and
Magnesium
Major Anion Chloride and
Bicarbonate
Phosphate, Sulphate
and Protein
9. Calculating Plasma Osmolality
Plasma = 2 X Na + Glucose ( mg/dl) /18 + BUN(mg/dl) /2.8
osmolality
The effective plasma osmolality is determined by those solutes in the
plasma which do not freely permeates cell wall and act to hold water
within the ECF.
So Lipid soluble solutes such as urea which can cross the cell memebrane
does not contribute to osmotic pressure gradient between ECF and ICF.
Effective osmolality = 2 X Na (mEq/L) + Glucose (mg/dl) / 18
(mOsm / Kg)
10. BASIC PRINCIPLES OF I.V. FLUID THERAPY
Advantage :-
1) Accurate, controlled & predictable way of administration.
2) Immediate response.
3) Prompt correction of serous fluid & electrolyte disturbances.
Indication :-
1) Condition when oral intake not possible. E.g.- coma, surgery.
2) Moderate to severe dehydration and shock.
3) Severe vomiting and diarrhea.
4) Hypoglycemia ,where 25% dextrose is life saving.
5) As vehicle for various I.V. medication. E.g.- antibiotics
6) Total parenteral nutrition
7) Treatment of critical problems like – Shock, Cardiac arrest, forced
diuresis in drug overdose, poisoning
11. Disadvantage :-
1) More expensive , need strict asepsis.
2) Improper selection of type of fluid used can lead to serious
problems.
3) Improper volume & rate of infusion can be life threatening.
4) Improper technique of administration can lead to complication.
Contraindication:-
1) Preferable to avoid in patients with congestive heart failure &
volume overdose.
Complication :-
1) Local - Hematoma, infiltration , infusion phlebitis.
2) Systemic - Circulation overload, Rigors, air embolism ,septicemia.
3) Others - Fluid contamination, mixing of incompatible drugs
12. Classification of I.V. Fluids
CRYSTALLOIDS :
Isotonic saline
Dextrose saline
5 % Dextrose
10 % Dextrose
25% Dextrose
Ringer lactate
Isotype – M
Isotype – E
SPECIAL FLUIDS :
Sodium Bicarbonate
Potassium chloride
COLLOID SOLUTION :
Albumin
Dextran
Gelatin polymers
Hetastarch
Pentastarch
BLOOD
14. Isotonic or normal saline (0.9% NaCl)
Composition:-
One litre fluid contains - Na+ = 154 mEq
Cl- = 154 mEq
Distributed chiefly in extracellular fluid, so it will increase intravascular volume
substantially
Indication:-
1) Resuscitation fluid in diarrhea, vomiting , excessive diuresis.
2) Treatment of Hypovolemic shock.
3) Initial fluid therapy in Diabetic ketoacidosis.
4) Fluid challenge in pre-renal ARF.
5) AS vehicle for certain drugs and can be safely given with blood.
Contraindication:
1) Avoid in hypertensive or pre-eclamptic patients.
2) CHF ,Renal diseases and cirrhosis.
15. Dextrose normal saline( 5% dextrose with 0.9%NaCl )
Composition:-
One litre fluid contains - Glucose = 50 gm
Na+ = 154 mEq
Cl- = 154 mEq
Distributed chiefly in extracellular fluid,
Indication:-
1) Correction of salt depletion and hypovolemia with supply of energy.
2) Fluid compatible with blood transfusion.
3) Correction of vomiting or nasogastric aspiration indused alkalosis.
Contraindication:
1) Anasarca – cautious use in anasarca of cardiac , hepatic and renal disease
2) Hypovolemic shock- Rapid infusion can cause Hyperglycemia and osmotic diuresis
even in presence of fluid deficit.
16. RINGER’s LACTATE
Composition:-
Each 1 Litre of fluid contains -
Sodium = 130 mEq Calcium = 3 mEq
Potassium = 4 mEq Bicarbonate = 28 mEq
Chloride = 109 mEq
Ringer lactate is the most physiological fluid as its electrolyte content is nearly similar
to that of plasma.
Because of high Sodium conc. It rapidly expands intravascular volume and so very
effective in treatment of severe hypovolemia.
Indication:-
1) Correction of severe Hypovulemia rapidly with large fluid volume.
2) For replacing fluid in post operative patients, burns , fractures etc.
3) Treatment of Diarrhia induced hypovolemia with hypokalemic metabolic acidosis.
4) In Diabetic keto acidosis , RL provides glucose free water.
5) For maintaining normal ECF fluid and electrolyte balance during and after surgery.
17. Contraindication:
1) Ringer lactate can lead to lactic acidosis in patients with Liver disease ,
Hypoxia and shock
2) Severe CHF.
3) Addison’s disease
4) In vomiting or continuous Nasogastric aspiration
5) Along with Blood transfusion
6) The calcium in RL binds with certain drugs like amphotericin, thiopental
and reduces their bioavailability and efficiency.
18. ISOLYTE – M (maintenance sol. With 5% dextrose)
Composition:-
One litre fluid contains - Glucose = 50 gm Phosphate = 15 mEq
Na+ = 40 mEq Acetate = 20 mEq
Cl- = 38 mEq
K+ = 35 mEq
• Isolyte – M is the richest source of potassium so very useful in treatment of hypokalemia
• Proportions of electrolytes in Isolyte-M is almost similar to maintenance requirement of the
body
Indication:-
1) For Parenteral fluid therapy ,it’s the ideal maintenance fluid.
2) To correct hypokalemia secondary to diarrhea , bilious vomiting etc.
Contraindication:
1) Acute and chronic renal failure.
2) Hyponatremia .
3) Adrenocortical insufficiency.
4) In patients with burns.
19. ISOLYTE – E (Extracellular replacement solution )
Composition:-
One litre fluid contains - Glucose = 50 gm Acetate = 47 mEq
Na+ = 140 mEq Ca ++ = 5 mEq
Cl- = 103 mEq Mg++ = 3 mEq
K+ = 10 mEq Citrate = 8 mEq
• Isolyte – E has electrolyte similar to ECF except double the conc. of potassium and
acetate.
• Only I.V. fluid available that can correct magnesium deficiency.
Indication:-
1) Diarrhea.
2) Metabolic acidosis.
3) Maintenance of ECF volume preoperatively.
Contraindication:
1) Vomiting
2) Continuous Nasogastric aspiration.
3) In metabolic alkalosis due to drugs and bicarbonate
21. Sodium Bicarbonate ( NaHCO3)
Composition:-
Commonly used preparation is 7.5%, 25 ml ampoule
One ampoule contains 22.5 mEq Sodium and 22.5 mEq Bicarbonate
Amount to be infused :-
Approximately 50% of the calculated deficit is corrected in 4 Hrs
and rest gradually over 24 hrs
Amount of NaHCO3 required (in mEq/L) =
0.5 X weight in Kg X ( Desired HCO3 - actual HCO3 )
22. Special precautions
1) Sodium bicarbonate should not be given as bolus except in
emergency.
2) Avoid overdose and alkalosis by giving repeated small doses and
monitoring pH
3) Never treat Acidosis without treating the etiology.
4) In presence of renal failure , treatment with sod. Bicarbonate
may cause tetany and pulmonary oedema.
5) Never correct acidosis without correcting the assosiated
hypokalemia. NaHCO3 will shift potassium from ECF to ICF , this
will aggravate hypokalemia
6) Never mix inj. Calcium with inj. NaHCO3 in same syringe as it
may precipitate calcium carbonate.
7) Avoid mixing of inj. NaHCO3 with inotropes.
23. Indication:-
1) Metabolic acidosis.
2) Cardiopulmonary resuscitation and shock.
3) Treatment of Hyperkalemia.
4) Alkaline forced diuresis in acute poisoning of barbiturates
and salicylates.
Complication:
Hypokalemia , volume overload , hypocalcaemia
Contraindication:
1) Respiratory and metabolic alkalosis.
2) Hypokalemia.
3) Cautious use in CHF , CRF , cirrhosis.
24. Injectable Potassium Chloride
Composition:-
Commonly used preparation is 15% KCl 10ml ampoule.
1 ml = 150 mg KCl = 2mEq Potassium.
So 1 ampoule = 10 ml = 20 mEq Potassium.
Indication:-
1) Added in potassium free I.V. fluids for prevention of Hypokalemia
2) For treating Hypokalemia.
3) Added to potassium free peritoneal dialysis fluid for maintaining proper K+
levels
25. Basic rules for using Inj. KCl :-
1) Never give direct I.V. KCl injection.
2) Always use injection potassium chloride diluted in infusion.
3) Never add more than 40 mEq / litre.
4) Never infuse more than 10 mEq / hr.
5) Never add KCl in Isolyte – M.
6) Moniter serum K+ levels closely.
Contraindication:-
1) Cautious use in renal failure as hyperkalemia is a potential risk.
2) Never use injection KCl without knowing potassium status.
27. ALBUMIN
Composition:-
Albumin is a physiological plasma protein.
Heat treated preparation of human serum albumin is commercially
available in a 5% solution (50 gm/dl) and a 25% solution (250 gm/dl).
As Sodium load is small, 25% albumin is also called salt poor albumin
Indication:-
1) For Plasma volume expansion in cases of acute hypovulemic shock, burns.
2) Correction of hypoproteinemia as in liver disease, nephrotic syndrome etc.
3) As an exchange fluid to replace removed plasma in therapeutic
plasmapheresis.
Adverse effect:
1) Nausea and vomiting.
2) Febrile reaction .
3) Allergic reaction and anaphylactic shock.
28. Precautions and contraindications :-
1) Fast infusion will rapidly increase circulatory volume with
resultant overload and pulmonary oedema.
2) Infusion of albumin solution is contraindicated in patients with
severe anemia or cardiac failure
3) Should be given with caution to patients with low cardiac
reserves.
4) Albumin solution should not be used for parenteral nutrition.
29. DEXTRAN
Composition:-
Dextrans are glucose polymers produced by bacteria incubated in sucrose media.
Available in two forms :
DEXTRAN 70 -- mol.wt 70,000
DEXTRAN 40 – mol.wt 40,000
Both forms effectively expand Intra vascular volume but can not be a substitute for
whole blood due to lack of oxygen carrying capacity and no clotting factors
Indication:-
1) For short term rapid expansion of plasma volume for correction of hypovolemia.
2) Prophylaxis of Deep vein thrombosis and postoperative thromboembolism.
3) To improve blood flow and microcirculation in threatened vascular gangrene.
Adverse effect:
1) Acute renal failure.
2) Hypersensitivity reaction.
3) It may interfere with blood grouping and cross matching..
30. Contraindication:
1)Severe oligo-anuria and renal failure.
2) Known hypersensitivity to dextran.
3) Severe CHF or circulatory overload.
4) Bleeding disorders.
5) Severe Dehydration.
Preacution:
1) The hematocrit should not be allowed to fall below 30.
2) Correct dehydration during dextran infusion to maintain
adequate urine flow.
3) Anticoagulant effect of heparin enhanced by dextran.
4) Along with dextran infusion patient may require blood
coagulation factor or electrolyte.
31. Volume Deficit-Clinical Types
• Total body water:
– Water loss (diabetes insipidus, osmotic diarrhea)
• Extracellular:
– Salt and water loss (secretory diarrhea, ascites, edema)
– Third spacing
• Intravascular:
– Acute hemorrhage
32. Clinical Diagnosis
Intravascular depletion
MAP= CO x SVR
Hemodynamic effects
• BP HR JVP
• Cool extremities
• Reduced sweating
• Dry mucus membranes
E.C.F. depletion
– Lost skin turgor,
– sunken eyeballs
– Weight loss
– Hemodynamic effects
Water Depletion
Thirst
Hypernatremia
33. Approach to IVF in the Medical Pt
• First let’s review the equation for estimating serum
osmolality:
Serum osmolality = 2 (Na+) + Glucose/18 + BUN/2.8
• See how much more sodium adds to your osmolality then
glucose does?
• That’s why D5 ½NS is inappropriate for most medical patients
who are hypovolemic.
• They need isotonic fluids (normal saline).
• Also, remember that dextrose gets almost immediately
metabolized to water and CO2 when it enters the circulation
so it is not osmotically active for too long.
34. The 4 Types of Patients
When considering appropriate IV fluids as you are writing
admission order, keep in mind that in general, there are
4 types of medical patients when it comes to
administering IV fluids:
Hypovolemic Patient
Pneumonia, Sepsis, Hemorrhage, Gastroenteritis
Hypervolemic Patient
CHF, renal failure, cirrohsis
NPO Patient, surgical patient, euvolemic
Awaiting surgery, unsafe swallow
Eating/drinking normally
35. Determining Appropriate IVF
Step 1: Assess volume status
• What is the volume status of my patient?
• Do they have ongoing losses?
• Can my patient take PO safely?
• Are the NPO for a reason?
Step 2: Determine Access
• Peripheral IV
• Central line
• IO line
37. Determining… Continued
Hypovolemic Patient
Always use Normal Saline for goal of volume resuscitation
Normal saline is almost isotonic with blood so it is the best choice!
On surgery or if going to administer more than 3-4L often use LR. (Addition of lactate that is metabolized to
bicarbonate to help buffer acidosis)
Hypervolemic Patient
Avoid additional IVF
Maintain access IV access with HepLock
NPO Patient now euvolemic
Administer maintenance fluids. Goal is to maintain input of fluids to keep up with ongoing losses and
normal fluid needs
For average adult NPO for more than 6-12 hours, consider D51/2NS at 75-100cc/hr
Consider pt co-morbidities
Constantly reassess, at least 2x day or with any change
Don’t give fluids blindly ie: if the patient is pre-procedure but is old (predisposed to fluid overload because
of stiff LV) or has history of CHF, be CAREFUL!
Pearl: the reason for giving dextrose (D5) is to prevent catabolism.
Daily I/O’s, watch lytes
Normal PO Intake
No need for fluids if they are taking PO without problems!
Avoid IVF
38. Determining… Continued
Step 4: Determine Rate
• In medical patients, the rate is always a ballpark and
you have to use your clinical judgement. (Not
applicable for PEDS!)
• If you are trying to fluid resuscitate that patient, you
might be giving fluids “wide open” or 500 cc/hr.
• The hypovolemic pt may need multiple 1L bolus to
reestablish intravascular volume
• If you are just giving fluids to the average patient,
give fluids at 75-100 cc/hr. Adjust for individual
patient
39. Holiday Segar Method
A peds method that can be helpful:
So a quick example:
For a 55 kg patient, the maintenance IV fluid rate would be
4*10 + 2*10 + 35*1 = 95 mL/hour.
40. Calculating Drip Rate
In the age of machines, we barely have to do this
anymore… but if you ever need to go old skool, here is
how to calculate the drip rate (drops/minute):
gtt = Volume to be infused (mL) x (gtt/mL)
min Time (minutes)
Drip Factor = (gtt/mL) Of the TUBING which is found on the
manufacturers pacakging
Example: Volume = 4000 ml
Time = 24 hours
Drip factor of tubing = 15 gtt/ml.
So…. [4000mL/(24h x 60min/h)] X 15gtt/ml = approx 42 drops/min
41. Example- GI Bleed
A 25 year old patient presents with massive hematemesis (vomiting blood) x 1
hour. He has a history of peptic ulcer disease.
Exam: Diaphoretic, normal skin turgor.
Supine BP: 120/70 HR 100
Sitting BP: 90/50 HR=140
Serum Na=140
What is the nature of his fluid deficit ?
What IV fluid resuscitation would you prescribe ?
What do you expect the hematocrit to be :
- at presentation ?
- after 12 hours of Normal Saline treatment?
42. Example- Diarrhea and Vomiting
• A 18 year old previously healthy medical student returns from a Caribbean
vacation with a healthy tan and severe diarrhea and vomiting x 48 hours.
• Sunken eyeballs, poor skin turgor and dry mucus membranes
• BP 80/70 HR 130 supine.
• Labs: Na 130 K=2.8
HCO3 =12
ABG: 7.26/26/100
• What is the nature of his fluid deficit ?
• What fluid will you prescribe ?
• What would happen if D5W were to be used?
43. Example- Hyperosmolar State
A 85 year old nursing home resident with dementia, and known
diabetes was admitted with confusion.
Exam: Disoriented, Decreased skin turgor
BP: 110/70 supine 90/70 sitting..
Labs: Na= 150meq/L Wt=50kgs
BUN/Cr=50/1.8 Blood sugar= 1200 mg/dl Hct=45
What is the pathogenesis of her fluid and
electrolyte disorder ?
How would you treat her ?
44. Calculation of Water Deficit
Osm (P Na) x
volume
Osm (P Na) x
volume
Healthy Dehydrated
A 50 kg female with Na=150
•Na x Normal Body Water = Na x Current Body Water
•140 x NBW = 150 x (0.5 x 50=25 liters)
•NBW = 26.8 liters
•Water deficit = NBW-CBW= 26.8-25=1.8 liters
46. The take-home message!
• Resuscitate with fluids early and aggressively
– They won’t get overloaded
– They won’t get pulmonary oedema
– They will be less likely to need ICU
• Be guided by markers of tissue perfusion
– Urine output
– Lactate
– Consider central venous oxygen saturations
47. Conclusions
• Crystalloids are generally adequate for most
situations needing fluid management.
• The composition of the solution and rate of
administration are important when addressing a
specific situation.
• Colloids may be indicated when more rapid
hemodynamic equilibration is required (inadequate
data).