principles of IV fluid therapy محاضره عن اساسيات استخدام المحاليل الطبيه الوريديه --انواعها - استخداماتها --فوائدها والمحاذير عند اعطائها

1. Principles of intravenous fluidPrinciples of intravenous fluid
therapytherapy
BYBY
Omar Mohammad SalehOmar Mohammad Saleh
Assistant Lecturer of Tropical Medicine andAssistant Lecturer of Tropical Medicine and
GastroenterologyGastroenterology
HUCOMHUCOM
22ndnd
April 2012April 2012

2. Learning objectivesLearning objectives
Historical aspect of intravenous fluid therapyHistorical aspect of intravenous fluid therapy
Basics of fluid therapyBasics of fluid therapy
Patient assessmentPatient assessment
Types of I.V fluid therapyTypes of I.V fluid therapy
Indications of I.V fluid therapyIndications of I.V fluid therapy
Complications of I.V fluid therapyComplications of I.V fluid therapy
Take home messagesTake home messages

7. Why is fluid therapy so importantWhy is fluid therapy so important??
11--It maintains the shape and integrity of all cells inIt maintains the shape and integrity of all cells in
the bodythe body
22--It maintains blood pressure/ volumeIt maintains blood pressure/ volume
33--A transport medium forA transport medium for;;
11..Delivery of nutrients and oxygen to theDelivery of nutrients and oxygen to the
tissuestissues
22..Removal of waste products from the bodyRemoval of waste products from the body
44--A medium for all the biochemical reactionsA medium for all the biochemical reactions
necessary for lifenecessary for life
Approximately 60% of the body is waterApproximately 60% of the body is water!!

8. The British Medical Journal published a letter sent fromThe British Medical Journal published a letter sent from
a concerned clinical researcher and a senior professora concerned clinical researcher and a senior professor
of surgery fromof surgery from Edinburgh (1). They surveyed 33Edinburgh (1). They surveyed 33
Foundation Year 1 doctorsFoundation Year 1 doctors (interns) during their first(interns) during their first
hospital rotation as doctors, testing their knowledge ofhospital rotation as doctors, testing their knowledge of
fluid and electrolyte balance, and ability to prescribefluid and electrolyte balance, and ability to prescribe
fluids correctly. They described the results asfluids correctly. They described the results as
“alarmingly poor”,“alarmingly poor”, and called for better and moreand called for better and more
formalized teaching of fluid administration in medicalformalized teaching of fluid administration in medical
schoolsschools..
MSJA • Volume 3 Issue 2 • October 2011MSJA • Volume 3 Issue 2 • October 2011

15. Composition of fluid compartmentsComposition of fluid compartments

17. Uses of intravenous fluidsUses of intravenous fluids
11--ResuscitationResuscitation
22--Rehydration / ReplacementRehydration / Replacement
33--MaintenanceMaintenance
44--Special purposeSpecial purpose

18. Goals of fluid therapyGoals of fluid therapy
11--To maintain adequate oxygen delivery toTo maintain adequate oxygen delivery to
the tissuesthe tissues
22--To maintain normal electrolytesTo maintain normal electrolytes
concentrationconcentration
33--To maintain normoglycemiaTo maintain normoglycemia

20. Assessment of volume statusAssessment of volume status
Look at the patient:Look at the patient:
- PulsePulse
- Blood pressureBlood pressure
- Capillary refillCapillary refill
- Skin turgorSkin turgor
- Mucous membranesMucous membranes
- Peripheral circulationPeripheral circulation

23. Autotransfusion by passive leg raising resulting in
changes in systemic hemodynamic variables such as
stroke volume or venous pressure.

24. Assessment of volume statusAssessment of volume status
Try a more invasive approachTry a more invasive approach::
--Urine outputUrine output
--Central venous lineCentral venous line
--PA catheterPA catheter
--Esophageal dopplerEsophageal doppler

26. ““If the eyes are the windows to theIf the eyes are the windows to the
soul, then the kidneys are thesoul, then the kidneys are the
windows to the bodywindows to the body””
Sandra OuelletteSandra Ouellette..

28. Assessment of volume statusAssessment of volume status
How about blood testsHow about blood tests??
--Urea and electrolytesUrea and electrolytes
--HaematocritHaematocrit
--Plasma/ urine osmolalityPlasma/ urine osmolality
--Arterial blood gasesArterial blood gases

29. Types of intravenous fluidTypes of intravenous fluid
CrystalloidsCrystalloids
ColloidsColloids
Blood/blood products and blood substitutesBlood/blood products and blood substitutes

30. What is the choiceWhat is the choice??
Colloid Vs CrystalloidColloid Vs Crystalloid

31. CrystalloidsCrystalloids
--Extracellular space expanderExtracellular space expander
--Net effect is 1/3 to ¼ of total fluid infusedNet effect is 1/3 to ¼ of total fluid infused
--Limited volume expansionLimited volume expansion
--Maintain urine output and renal functionMaintain urine output and renal function
--Reduce plasma oncotic pressure by dilutingReduce plasma oncotic pressure by diluting
plasma proteinplasma protein
--Variable electrolyte contentVariable electrolyte content
--CheapCheap

32. Types of crystalloid solutionsTypes of crystalloid solutions

35. ColloidsColloids
--Intravascular space expanderIntravascular space expander
--Volume for volume expansionVolume for volume expansion
--Maintain oncotic pressureMaintain oncotic pressure
--Coagulation problemsCoagulation problems
--Variable electrolyte content and half lifeVariable electrolyte content and half life
--Adverse reactionsAdverse reactions
--ExpensiveExpensive

39. Every day in the hospital, physicians areEvery day in the hospital, physicians are
required to write orders for intravenous fluid,required to write orders for intravenous fluid,
but when asked to explain their choices, fewbut when asked to explain their choices, few
are completely comfortable with justificationare completely comfortable with justification
for the orderfor the order..

40. Rule 1: Do Not Be Generous with FluidRule 1: Do Not Be Generous with Fluid
Rule 2: The Source and Magnitude of Usual WaterRule 2: The Source and Magnitude of Usual Water
Output Must Be KnownOutput Must Be Known
Rule 3: Know the Quantities of the Electrolytes andRule 3: Know the Quantities of the Electrolytes and
Nutrients That Are Being GivenNutrients That Are Being Given
Rule 4: Know the Aim of Fluid TherapyRule 4: Know the Aim of Fluid Therapy
Rule 5: Do Not Give and Remove the SameRule 5: Do Not Give and Remove the Same
Substance at the Same TimeSubstance at the Same Time

41. Rule 6: Hypertonic Saline Contains Less Water for a GivenRule 6: Hypertonic Saline Contains Less Water for a Given
Amount of Na+ than Isotonic SalineAmount of Na+ than Isotonic Saline
Rule 7: Be Familiar with Different i.v. Solutions and i.v.Rule 7: Be Familiar with Different i.v. Solutions and i.v.
AdditivesAdditives
Rule 8: Know that the Kidney Does Not ManufactureRule 8: Know that the Kidney Does Not Manufacture
Water or ElectrolytesWater or Electrolytes
Rule 9: For Short-Term Fluid Therapy, Water, Glucose andRule 9: For Short-Term Fluid Therapy, Water, Glucose and
Perhaps NaCl and Phosphate Need to Be Given –Perhaps NaCl and Phosphate Need to Be Given –
Divalent Cations (Ca2+, Mg2+) Do Not NeedDivalent Cations (Ca2+, Mg2+) Do Not Need
ReplacementReplacement

45. How should fluids beHow should fluids be
administeredadministered??

49. Take home messageTake home message!!
11--Beware of treating a lab valueBeware of treating a lab value!!
22--Fluid needs are not static always re-assessFluid needs are not static always re-assess
33--Remember that % refers to gram/ 100mlRemember that % refers to gram/ 100ml
44--Pure water given IV causes massive hemolysisPure water given IV causes massive hemolysis
(dangerous(dangerous((
55--No single sign is pathognomonic for volumeNo single sign is pathognomonic for volume
status assessmentstatus assessment

50. Say to me I will forgetSay to me I will forget!!!!!!
Show me I will rememberShow me I will remember!!
Involve me I will understandInvolve me I will understand