FLUID THERAPY AND
FLUID RECONSTITUTION
RATIOS;D10%, D25%
FLUID THERAPY.
IV FLUIDS ( INTRAVENOUS FLUIDS ). These are fluids used in intravenous therapy to restore
or maintain normal fluid volume when the oral route is not possible.
DISTRIBUTION OF BODY FLUIDS.
Body fluids are:
intracellular (Fluids in the cell)
extraccellular (fluids in the intravascular( fluids with in the blood vessels)interstitial, and
transcellular(eg aqeous humor, saliva, cerebralspinal fluids, plural, peritoneal synovial, lymphatic
system fluids and GIT secretions)
Extracellular fluids transports nutrients, oxygen, and waste products to and from the cells.
How does water move?
Osmosis: Movement of water through a semi pemipermeable membrane across a concentration
gradient.
• water moves from area of low particles concentration (hpotonic) to area of high particle
concentration (hypertonic) utill the concentration is equal
why do fluids move? Hormones!
.
Changes in blood pressure, blood volume, plasma osmolarity (blood concentration) triggers alteration in
hormones
.
The goal is to keep the body isotonic. ( keeping equal concentration of particles
between the Extracellular fluids and intracellular fluids)
• Replace the fluid volume or correct an imbalance
• Two types of imbalance; fluid volume deficit and fluid volume overload.
TONICITY OF FLUIDS.
Hypotonic fluids.
• Seen in NPO or post surgical patients to help replace intracellular fluids that
occur during surgery or with malnutrition.
• Do not administer if the patient is hypotensive, has increased intra cranuial
pressure, has liver dsfunction, or trauma with a suspected head injury.
• if used continously water intoxification can occur.
.Isotonic fluids .
• Restores Extracellular Fluid volume and replaces Sodium and Chloride deficit
• useful for rehydration or replacement as its similar to plasma.
• Normal saline contains sodium and Chlorine ions and is the most similar to human plasma.
• Ringers lactate is similar to electrolyte concentration of plasma secondary to NS. Given
following trauma or surgery.
Hypertonic Fluids.
• Constant use of hypertonic fluids can lead to dehydration.
• These fluids shrink the cell, it can lead to dehydration.
• Most hypertonic fluids becomes hypotonic when in the body (dextrose is metabolized and
leaves hypotonic solutions)
USE OF DESTROSE IN IV FLUIDS.
In the hospital setting we are going to see D50%, D5%, D10%, and D25%
• used in management of hypoglycemia.
.
How to make Destrose ; IV [Link] what you want
For example;
We want a total volume of 300mls of 25% Dextrose. (we have 50%
Dextrose)
How to calculate IV flow rate on a giving set.
.
Examples of calculating drops per minutes (ggt/min)
[Link] healthcare provider orders 1000mls of normal saline over 8 hours.
The drop factor on the tubing is 20drops per ml. The flow rate should be
how many drops per minutes?
[Link] IV fluids od Dextrose at 50mls per hour. If micro drip
tubing is used you would regulate the IV at how many drops per
minute?
NB: Micro drip tubing is a constant drop factor (60 drops/MLs)
COMPLICATIONS OF IV LINES.
PROBLEM SEE ACTION PREVENTION
Infiltration/ • Swelling at the site • STOP the iv and start a new line Select a good site
Extravasation • Decreased temperature at the site • Elevate the arm
(IV Fluids link into the • Slowed infusion • Apply warm compress
surrounding tissue) • Pallor( pale at the site of infusion) • Start another iv
Phlebitis (inflammation of • Pain • STOP the iv and start a new line • Rotate the site after 72hours
the veins) • Redness • Elevate the arm • Wash your hands
• Tenderness at the site • Apply warm compress
• Occlusion (due to decreased iv flow) • Start another iv
Cellulitis (inflammation of • Pain • Specimen for culture if drainage is • Rotate the site after 72hours
the tissue) • Warmth present • Wash your hands
• Edema
• fever
Hematoma (collection of • Build up of the blood in the tissue after iv • NO alcohol, • Minimize tourniquet time.
blood in the tissues) is removed • Apply pressure after iv catheter is • Pressure after catheter removal
removed
• Apply cold compress
FLUID AND ELECTROLYTES.
•70% of our body is made up of water. How ever NOT just plain water but it consists of [Link] is to
say, potassium, sodium, chloride, calcium, phosphate and magnesium. ( SO, these are substances that once they
enter the body and become dissolved they cause an electric charge in our body. Hence they become ions ).
FUNCTIONS OF ELECTROLYTES.
• Contraction of musles
• Sending nerve impilses.
• Bone formation
• Osmosis( balancing the fluids in our body)
• Maintaining the blood`s Acid-Base balance.
•(Therefore, when ever we have some imbalances in these electrolytes you start to see some abnormalities in
these processes.)
ELECTROLYT
FUNCTIONS HYPER (HIGH) HYPO (LOW)
ES
HYPER(excess) KAL (potassium)
POTASSIUM pumps the EMIA(blood), hyperkalemia
heart (over 5) manifestation (S&S)
• Heart = HIGH pumps HYPOKALEMIA (below 3) Manifestation
Foods that cointain • Severe V Fib & Cardia arrest (S&S)
potassium • Hypotention Heart = low and slow pumps
P (Potatoes, pork) • Bradycardia Neuromuscular = low &slow
O (Orange ) Neuromuscular = high shallow respirations most DEADLY
T (Tomatoes) Increase DTR Decreased DTR
A (Avocadoes) Paralysis & paresthesia (tingling) Muscle craping &flaccid paralysis (Paralyzed limbs)
POTTASIUM muscle weakness (general feeling of heaviness)
S (Straw berries) GI = low & slow
(3.5 - 5.0 ) GI = HIGH pumps
S (Spinach) constipation
f I sh Diarrhoea hypoactive bowel sounds
(mUshrooms) hyper active bowel movement. paralytic illeus (paralyzed intestine)
M (Melon) CAUSES CAUSES.
• Renal failure • Fluid loss,electrolyte loss
• low aldosterone( E.g In hypertensive patients • where fluids flow, electrolyte gooo..........
that are on ACE’s inhibitor’s) • Dirrhoea, Diuretics, Diet, DKA, Aldosterone
• Burns (intracellular K moves into
extracellular),
• Excessive potassium intake
SODIUM (135 -145) Sodium Swells the body HYPERNATREMIA HYPONATREMIA
Processed cheeses and
canned soups are high in Maintains
sodium. • Blood pressure
poultry, fish, fruits, and • Blood volume
fresh vegetables have • PH balance
small amount of sodium.
‘
ETC
Additional key points to note done on fluids.
As we age, there is loss of thirst sensation
The kidney are less efficient with age and with most chronic diseases
Infants kidney reabsorb less fluids.
Elderly have less anti diuretic hormone and diminished thirsty sensation