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Colloid versus Crystalloid in Hypovolemic Shock Controversy

Colloid versus Crystalloid in Hypovolemic Shock Controversy. www.anaesthesia.co.in. email: anaesthesia.co.in@gmail.com. Crystalloids Fluids comprised of water and electrolytes or simple crystals Volume of distribution-intravascular,interstitial space Volume - 3 : 1

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Colloid versus Crystalloid in Hypovolemic Shock Controversy

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  1. Colloid versus Crystalloidin Hypovolemic ShockControversy www.anaesthesia.co.in email: anaesthesia.co.in@gmail.com

  2. Crystalloids Fluids comprised of water and electrolytes or simple crystals • Volume of distribution-intravascular,interstitial space • Volume - 3 : 1 Examples • Ringer’s lactate, hypertonic saline, normal saline

  3. Colloid • High molecular weight substances • Volume of distribution -intravascular space • Volume – 1: 1 • Exert colloid osmotic pressure • Costly Examples • HES, Haemaccel, Albumin, Dextran

  4. Albumin • 5%, 20% and 25% • Half life – 16 hr • Colloidal osmotic pressure - (25%) - 70 mmHg •  plasma volume by 400-500 ml • Vol. expansion occur at expense of interstitial fluid so 25% should not be used for resuscitation • Side effects – allergic reaction

  5. Haemaccel • Synthetic colloid • Degraded gelatin • Concentration - 3.5% • Half life – 2-3 hr • Dose – 20 ml/kg/day • Osmotic pressure – 300 mmHg • Side effects – anaphylaxis, coagulation interference (high dose)

  6. Hydroxyethyl starch

  7. Crystalloids vs Colloids Proponents of colloid fluid • Resuscitation crystalloid solution dilutes plasma proteins • Reduction of plasma oncotic pressure • Interstitial pulmonary edema • Requires smaller initial volume, generate prolonged  in circulating plasma volume • Isotonic crystalloid – must be infused at least three fold greater volumes- to achieve comparable plasma expansion and hemodynamic stability

  8. Proponents of crystalloid solution • Additional cost and potential risk of colloids • Removal of colloids- requires longer period than crystalloids in burn and major surgical patients • Sepsis, ARDS, surgical trauma,  capillary permeability  leak  edema • Coagulopathy – Dextran, HES >20 ml/kg •  ionised calcium albumin • Impaired cross-matching – Dextran • Osmotic diuresis  LMW dextran

  9. literature

  10. What to do ? • According to literature: • Crystalloids - first preference-when available(NS,R/L) • Colloids –Keeping in view of adverse effects and dosage ,colloids can be given with crystalloids • Avoid albumin as resuscitative fluid

  11. THANK YOU

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