This document discusses different types of intravenous fluids used in anesthesia. Fluids are divided into crystalloids and colloids. Common crystalloids include Ringer's lactate, normal saline, and glucose solutions. Common colloids discussed include dextrans, albumin, gelatins, hydroxyethyl starch, and blood. Each type of fluid is described in terms of its composition, uses, advantages, and disadvantages. Guidelines for blood transfusion and issues with mixing different IV fluids are also summarized.

1. L E C T U R E R : U M A R T A R I Q
M S C O T T / A N A E S T H E S I A
FLUIDS

2. FLUIDS
Fluids are divided into crystalloids and
colloids
CRYSTALLOIDS
Ringer lactate
Normal saline
Glucose solutions
Dextrose normal saline
Hypertonic saline

3. COLLOIDS
 Dextrans
 Albumin
 Gelatins
 Hydroxyethyl starch
 Blood

4. CRYSTALLOIDS
1. Ringer lactate solution(Hartman
solution)
 It is the lactated ringers solution, which is
modified NS in which some of the sodium
molecules are replaced by potassium and
calcium.
 RL is given to correct electrolyte loss and
fluid loss in the patients e,g diarrhoea ,
vomiting.
 Lactate is metabolised to bicarbonate in
liver.

5.  Ringer lactate is slightly hypotonic.
 Blood should not be given through the
same drip set(because RL contains
calcium)
 Ringer lactate is a crystalloid of choice
for blood loss replacement.

6. Composition of ringer lactate is
 Na 131 mEq/l
 Cl 111 mEq/l
 K 5 mEq/l
 Ca 2 mEq/l
 Lactate 29 mEq/l
pH=6.5

7. 2. NORMAL SALINE
 It is a solution of 0.9% NaCl which is isotonic.
 NS is given to compensate dehydration and sodium
loss in cholera and excessive sweating patients .
 It is also used as day care fluid in patients admitted in
hospitals.
 It is preferred over ringer lactate for treating ;
1. Hypochloremic metabolic alkalosis.
2. Brain injury(Ca in lactate can increase the neuronal
injury)
3. Hyponatermia
 Ph= 5.5
 commonly used crystalloid

8. Composition of Normal saline
 Na 154 mEq/l
 Cl 154 mEq/l

9. GLUCOSE SOLUTIONS(5% ,10% dextrose)
 These are isotonic but with the metabolism glucose
inside body becomes hypotonic.
 Blood cannot be given through the same drip set
otherwise rouleaux formation will cause clumping of
RBC`S.
 It is used to treat low blood sugar or water loss
without electrolyte loss.

10. DEXTROSE NORMAL SALINE (DNS)
 DNS is hypertonic
 1/5 NS + 4.3% dextrose and 5% dextrose + ¼ NS are
isotonic solutions.
 These are best used as maintenance of fluids.
 Used to supply water, calories and electrolytes(e,g
sodium chloride) to the body

11. HYPERTONIC SALINE
 used for treating
hyponatermia
cerebral and pulmonary edema.

12. COLLOIDS
1. DEXTRANS(Lomodex)
 Available as dextran 70 (mol.wt. 70,000
Daltons),150 (mol.wt. 1,50,000) and 40 (mol.wt.
40,000 Daltons).
 Dextrans are polysaccharides
 These solutions can be stored for 10 years
 Half life of dextran is 2-8 hours

13. ADVANTAGES
 Dextrans are non toxic , neutral and chemically inert.
 Low molecular weight dextran (dextran 40 ) improves
microcirculation.
DRAWBACKS
 Dextrans interfere with blood grouping and cross
matching(because they can cause red cell aggregation)
 Interferes with platelet function
 Can cause severe anaphylaxis
 Large molecular weight dextrans can block renal tubules
 ARDS (rarely) because of direct toxic effect on
pulmonary capillaries.

14. ALBUMINS
 Available as 5% and 25% solution.
 These are very expensive
 Albumin has intravascular halflife of 10-15 days
 Used when there is protein loss from the body like in
I. Peritonitis
II. Liver failure
III. Burns
IV. Protein losing enteropathies

15. GELATINS(Haemaccel)
 Molecular weight is 30,000
 Available as 3.55 solution.
 Expand plasma effectively for 2 hours(25% may be
present in blood after 12 hours)
 Gelatins do not interfere with blood grouping,
platelet function and clotting but at high doses they
can also interfere with clotting .
 Incidence of severe anaphylactic reactions is very
less.
 Haemaccel contains high calcium therefore citrated
blood should not be mixed

16. Composition of haemaccel:
Each liter contains:
 Gelatin 35 g
 Sodium 145 mEq
 Chloride 145 mEq
 Potassium 5 mEq
 Calcium 12 mEq

17. HYDROXYETHYL STARCH
 Two kinds of hydroxyethyl straches are available
1. Hexastarch 2. Pentastarch.
 Available as 6% & 10% solution.
 Prolonged half life
 Expand plasma effectively for 4 hours.
 Improves microcirculation & hence improves oxygen
delivery to tissues.
 At clinically used dose they do not interfere with
clotting but at high doses (>20ml/kg) they also
interfere with clotting.
 Anaphylactic reactions are less common

18. Hextends
 Hextends is another hydoxylethyl starch which also
has glucose and lactace but it is under trails and is
considered to effect coagulation less than
hydroxylethyl starch.

19. BLOOD
 In adults with normal HB and hematocrit blood loss
more than 20 % of their blood volume should be
replaced with blood while in western countries more
than 25-30%.
 Losses less than 20% can be replaced with
crystalloids and colloids( crystalloids preferred)
 In children's losses more than 10% is replaced with
blood while in western countries losses more than
15% is replaced with blood.

20.  Minimum acceptable HB level for elective surgery is
10 g% and hematocrit 35%
 1 unit of blood raises 0.8 g% in india while in
western countries by 1 g% because in india 1 unit of
blood = 350 ml(301 ml of blood and 49 ml of
anticoagulants) while in western countries 1 unit
contains 450 ml of blood(out of which 63 ml is
anticoagulant).
 One unit of fresh blood(with 100% RBCs while
stored blood has only 70 & RBCs) increases HB by 1
g%

21.  Blood products should not be mixed with 5 %
dextrose (dextrose can cause hemolysis.
 RL and Haemaccel contains calcium which with
citrate can induce clot formation.