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Intravenous Fluids

The document discusses different types of intravenous fluids including crystalloids like normal saline and dextrose solutions as well as colloids like albumin, dextran, gelatins and hydroxyethyl starches. It provides details on their composition, indications, and side effects. The document also discusses maintenance fluid requirements using the 4-2-1 rule.

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117 views19 pages

Intravenous Fluids

The document discusses different types of intravenous fluids including crystalloids like normal saline and dextrose solutions as well as colloids like albumin, dextran, gelatins and hydroxyethyl starches. It provides details on their composition, indications, and side effects. The document also discusses maintenance fluid requirements using the 4-2-1 rule.

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Intravenous Fluid

TOTAL BODY WATER


• Approx. 60% Body weight
• Varies with age, gender and
body habitus
• 50% BW in females
• 80% BW in infants
• Less in obese : fat contain little
water
Body Water Compartments
• Intracellular volume : 2/3 of TBW
• Extracellular volume : 1/3 of TBW
- Intravascular : Plasma volume (1/4)
- Extravascular: Interstitial fluid &
others(3/4)
Intravenous Fluids
Therapy
Intravenous fluid therapy may consist of
infusions of crystalloids, colloids, or a
combination of both.
Types
• Crystalloids
• Colloids
Crystalloids
• Clear fluids made up of water and electrolyte
solutions; Will cross a semi-permeable
membrane
• Grouped as isotonic, hypertonic, and hypotonic
• Eg:
• Normal saline 0.9%,3 %
• Dextrose solutions 5 %,10%,20%,25%
• DNS
• Ringer’s lactate
• Isolyte P
Crystalloids
• 0.9% Normal Saline
• Contains: Na+ 154 mmol/l, Cl- - 154 mmol/l
• IsoOsmolar compared to normal plasma.

• Indication :
• Intravascular resuscitation and replacement of
salt losses e.g. diarrhoea and vomiting.
• Also for diluting packed RBCs prior to transfusion
• Used for diluting Drugs
• Distribution:
• Stays almost entirely in the extracellular
space.Of 1 litre - 750ml extra vascular fluid;
250ml intravascular fluid.

• Complications:
• When given in large volume can produces
Hyperchloremic metabolic acidosis because
of high Na+ and Cl- content.
3.0 % Saline = HYPERtonic saline

• 3% contain 513 mmol/l of Na+ and


Cl- each,
• Indications :
• Treatment of severe
symptomatic hyponatremia
(coma, seizure)
• To resuscitate hypovolemic
shock
• Must be administered slowly
due to risk of phlebitis
5% Dextrose (often written D5W)

Regarded as ‘electrolyte free’

• INDICATIONS:

• To maintain water balance in patients who are not


able to take anything by
• mouth;
• Used post-operatively in conjunction with salt
retaining fluids ie saline
• Hypernatremia treatment
Ringer Lactate
• Electrolyte composition similar to ECF

• Indications :
• Deficit ,Intraoperative fluid loss
• Severe hypovolemia
• Precautions:
• Severe metabolic acidosis ( impaired lactate
conversion)
• Don’t give with blood product ( Ca bind with citrate
reduced anticoagulant activity )
DNS
• Multiple electrolyte & dextrose solution
• Isotonic
Indication :Pediatric maintenance fluid

IsoLyte -P
• 0.9% saline & 5% dextrose
Indication :
• Maintenance solution
• Correction of fluid deficit with
supply of energy
• Compatible with blood
Colloids
• Particles which do not readily cross
semi- permeable membranes
• Stay intravascular for a prolonged
period compared to crystalloids.
• NATURAL :Albumin
• ARTIFICIAL: Gelatin, Dextran and
HES
ALBUMIN
• Principal natural colloid comprising of 50-60% of all
plasma proteins.

Used:
• For emergency treatment of shock especially due to
loss of plasma
• Acute management of burns
• Fluid resuscitation in ICU
• Hypoalbuminemia

Side Effects:
pruritis, anaphylactic reactions, coagulation
abnormalities.
DEXTRAN

• Highly branched polysaccharide molecules


• Most widely used are 6%(dextran 70) and
10% (dextran 40) soln.
• Excreted via kidney primarily.
GELATINS
• Large mol. wt. proteins formed from hydrolysis
of collagen.
• Gelatins lead to 70-80% of vol expansion
• Indication :
• Rapid expansion of intravascular volume and
correction of hypotension
Advantage :
cost effectiveness and no renal or
coagulation impairment.
Disadvantage :
• Hypersensitivity
• Anaphylactoid reactions
HYDROXYETHYL STARCHES
• Derivatives of amylopectin, which is a
highly branched compound of starch.
• Duration of vol expansion is usually 8-12 H.
• Advantage
Cost effective: cheaper and comparable vol of
expansion to albumin.
• Disadvantage: Coagulation abnormalities
- Accumulation
- Anaphylactoid reactions
- Renal impairment
Colloid or Crystalloid Resuscitation
Recommendations:
• Colloid should NOT be used as the sole fluid
replacement in resuscitation.
• Colloid may be used in limited volume to
reduce volume of fluids required or until blood
products are available.
Maintenance Fluid Requirements
• 4-2-1 Rule
• 4 ml/kg/hr for the first 10 kg of body weight
• 2 ml/kg/hr for the second 10 kg body weight
• 1 ml/kg/hr subsequent kg body weight

Eg : 70 Kg pt
Maintenance fluid : 40+20+50= 110 ml/hr

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