The document covers renal physiology and the application of intravenous (IV) fluids in clinical settings, detailing the body water compartments and the distribution of electrolytes. It discusses various forms of IV fluids, including dextrose, saline, and lactated Ringer's, alongside their tonicity, uses, and clinical correlations. Additionally, it addresses the caloric expenditure method for determining maintenance IV fluid requirements in patients unable to eat or drink.

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RENAL PHYSIOLOGY
(VI)
M
INTRAVENOUS FLUIDS
(APPLIED PHYSIOLOGY)
Mohammed Abdel Gawad

2. OBJECTIVES
2
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

3. OBJECTIVES
3
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

4. Total body water Compartments
4

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. Water, Electrolytes & Non-Electrolytes
Distribution (1)
6

7. Water, Electrolytes & Non-Electrolytes
Distribution (2)
7

8. Osmolality of all three compartments
8
 Osmolality of all three compartments is the
same, because water is able to move freely
among all three compartments

9. OBJECTIVES
9
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

10. Intravenous fluids forms
10

11. Applied physiology of IV fluid
11
 Answer this points in every IV fluid type:
 1- Content?
 2- Tonicity?
 3- Distribution, water where are u? Use in volume replacement?

12. Tonicity
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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. 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. OBJECTIVES
14
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

15. Dextrose solutions: Content & Tonicity
15
 Glucose content ?
 Tonicity ?

16. Dextrose solutions: Distribution
16

17. Dextrose solutions: Distribution
17
 Dextrose solutions are a poor choice for intravascular volume
replacement

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. OBJECTIVES
19
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

20. Saline solutions: Content & Tonicity
20
 NaCl content ?
 Tonicity ?

21. Saline solutions:
Distribution: Isotonic Saline 0.9%
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 Used for treatment of dehydration & hypovolemia

22. Saline solutions:
Distribution: Hypotonic Saline 0.45%
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 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. Saline solutions:
Distribution: Hypertonic Saline 3%
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 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. OBJECTIVES
24
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

25. Lactated Ringer’s: Content & Tonicity
25
 Content ?
 Tonicity ?

26. Lactated Ringer’s: Distribution
26
1 liter
750 ml 250 ml

27. Lactated Ringer’s: Caution
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 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. OBJECTIVES
28
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

29. Plasma expanders
29
 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. IV solutions: Distribution
30

31. OBJECTIVES
31
 Body water compartments
 Electrolytes & Non-Electrolytes distribution
 IV fluids forms
 Dextrose
 Saline
 Lactated Ringer’s
 Plasma expanders
 IV fluids – Clinical Correlation

32. IV solutions: Clinical correlation:
Caloric Expenditure Method
32
 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. IV solutions: Clinical correlation:
Caloric Expenditure Method
33
 1- detect calories consumed/day by:
 a- Holiday-Segar method: (depend on weight)
 b- Body surface area:

34. IV solutions: Clinical correlation:
Caloric Expenditure Method
34
 2- detect amount of water & electrolytes that be
suspect to be lost by these calories.
 Special situations:

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Gawad