Intravenous fluid

• Intravenous fluid administration


  Should be considered as any other pharmacological prescription
• Main indications for intravenous fluid administration

  • Resuscitation
  • Replacement
  • Maintenance
• Maximizing benefits and minimizing harms of intravenous fluid administration

  Follow the four Ds: Drug, Dosing, Duration, De-escalation
• Drug


  Consider the indication for the fluid and what effect is being sought
• Duration of therapy


  Consider when to start and when to stop therapy
• Dosing


  Consider how much fluid to give
• De-escalation


  Consider when the fluid therapy is no longer effective or required
• Osmolarity


  The number of osmoles per liter of solution
• Tonicity


  A term that refers to the effect a solution has on cell volume
• Isotonic solution


  • Has no effect on cell volume
• Hypotonic solution


  • Increases cell volume
• Hypertonic solution


  • Decreases cell volume
• Fluids classification based on ability to diffuse through barriers


  • Intravascular
  • Extravascular (interstitial)
• Crystalloids


  Aqueous solutions composed of water and small solutes
• Colloids


  Solutions composed of water and large MW particles like proteins or hydroxyethyl starches

  
• Crystalloid solutions have a shorter intravascular half-life (20-30 min) compared to colloid solutions (3-6 h)
• When crystalloids are given in sufficient amounts


  They are effective as colloids in restoring intravascular volume

  
• Replacing an intravascular volume deficit

  Requires 3-4 times the volume when using colloids
• Rapid administration of large amounts of crystalloids (>45L)


  Is associated with tissue edema
• Tissue edema can impair oxygen transport, tissue healing, and return of bowel function following major surgery
• Infusion of 1 L of 0.9% NaCl

  Adds 275 mL to the plasma volume and 825 mL to the interstitial volume
• The total volume expansion (1100 mL) is slightly greater than the infused volume (1 L)
• Isotonic saline is slightly hypertonic to the plasma


  This results in a fluid shift from the intracellular to extracellular space

  
• Indications for 0.9% Sodium Chloride (Normal Saline)

  • Extracellular fluid replacement
  • Treatment of metabolic alkalosis with fluid loss
  • Mild sodium depletion
  • Diluent for compatible drug infusions
  • Traumatic brain injury or brain edema
  • Replacement fluid in hyperkalemia

  
• 0.9% Sodium Chloride is the preferred solution for diluting packed RBCs prior to transfusion

  
• 0.9% Sodium Chloride is used in DKA when there is severe hypovolemia and when

  
• فم


  رتوتلا ًلايلق ةبسنلاب امزلابلل
• 0.9% Sodium Chloride (Normal Saline)


  مويدوصلا ديرولك %0.9 (لولحملا يحلملا يداعلا)

  
• Indications لولحملا( مويدوصلا ديرولك %0.9 يحلملا يداعلا)

  • Extracellular fluid replacement (e.g.dehydration, hypovolemia, hemorrhage, sepsis)
  • Treatment of metabolic alkalosis in the presence of fluid loss
  • Mild sodium depletion
  • Diluents for the infusion of compatible drug additives
  • Used also in traumatic brain injury or any brain edema
  • Replacement fluid in hyperkalemia

  
• Preferred solution for diluting packed RBC prior to transfusion
• Used in DKA when there is severe hypovolemia and when serum sodium less than 140meq/L

  
• Hypertonic saline


  لولحم يحلم طرفم رتوتلا

  
• Uses of Hypertonic 3%, 7.5% or 23.4% saline


  • Therapy of severe symptomatic hyponatremia
  • Severe brain edema
• 0.45% Sodium Chloride


  زيكرت ضفخنم رتوتلا نم ديرولك مويدوصلا

  
• Hypotonic concentrations of sodium chloride (0.45%)


  Best for parenteral maintenance fluids rather than aggressive intravascular volume repletion

  
• Lactated Ringer's


  لولحم يتاتكلالا رغنير ،مدلا عم رتوتلا ُّيِوْسِإ لولحم ،ىطعُي نأ نكميو ربع ديرولا دعمو ،تحت دلجلا
• Ringer's solution: introduced in 1880 by Sydney Ringer (UK) who studied mechanisms of cardiac contraction
• The solution was designed to promote the contraction of isolated frog hearts, and contained Ca+ and K+ in a sodium chloride diluent
• In the 1930s Alexis Hartmann (American pediatrician) proposed the addition of sodium lactate buffer to Ringer's solution for the treatment of metabolic acidosis
• Lactated Ringer's


  نامتراه لولحمب ااضيأ ينبللا رجنير لولحم فرعُي