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IV FLUIDS

IV FLUIDS. Basic Principles. BASIC PRINCIPLES. Osmolality/Osmolarity Tonicity Sodium & Water balance. What is Osmolality?. OSMOLALITY. Measurement of concentration of particles in a solution (Total concentration of penetrating & nonpenetrating solutes)

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IV FLUIDS

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  1. IV FLUIDS

  2. Basic Principles

  3. BASIC PRINCIPLES • Osmolality/Osmolarity • Tonicity • Sodium & Water balance

  4. What is Osmolality?

  5. OSMOLALITY Measurement of concentration of particles in a solution (Total concentration of penetrating & nonpenetrating solutes) • i.e. Concentration of electrolytes, drugs, glucose in a solution such as serum or urine

  6. OSMOLALITY • Normal = 285-295 mOsm/kg • The ICF and ECF are in osmotic equilibrium

  7. OSMOLALITY • OSMOLALITY = mOsm/kg of solvent • OSMOLARITY = mOsm/liter of a solution

  8. What is Tonicity?

  9. TONICITY measure of the ability of a solution to cause a change in the volume or tone of a cell by promoting osmotic flow of water (Total concentration of penetrating solutes only)

  10. TONICITY

  11. Who regulates osmolality?

  12. Water

  13. WATER BALANCE Important in the regulation of osmolality Modification of water intake and exretion

  14. 60% ICF TOTAL BODY WATER ECF Interstitial Fluid Plasma

  15. FORCES THAT MOVE WATER Osmolality Tonicity Na/K ATPase pump Hydrostatic pressure Oncotic pressure

  16. SODIUM BALANCE The main regulator of intravascular volume status

  17. Electrolyte composition EXTRACELLULAR FLUID INTRACELLULAR FLUID

  18. WHAT IS THE BODY’S GOAL? • PHYSIOLOGIC HOMEOSTASIS • EUVOLEMIA • ISOTONIC ENVIRONMENT

  19. What mechanisms in the body makes sure that the balance of sodium and water is normal? What hormones play a big role in the maintenance of physiologic homeostasis?

  20. There are upper & lower limits to the amount needed to achieve ideal physiologic homeostasis

  21. WATER REPLACEMENT 1.5 to 2 liters / day

  22. SODIUM REQUIREMENT • DIET: RDA = < 2400mg/day (1 teaspoon/day) or < 104 meq/day • PLASMA : Normal levels = 135-145meq/L • FOR Na CORRECTION: • Maintenance of 2-4 meq/kg/day

  23. Intravenous Fluids

  24. INTRAVENOUS FLUIDS • chemically prepared solutions • Achieve and maintain a euvolemic and isotonic environment within the body • They are tailored to the body’s needs and used to replace lost fluid and/or aid in the delivery of IV medications

  25. ISOTONIC IV FLUIDS • created to distribute evenly between the intravascular, interstitial, and cellular spaces.

  26. HYPOTONIC IV FLUIDS What IV fluids are specifically designed so the fluid leaves the intravascular space and enters the interstitial and intracellular spaces?

  27. HYPERTONIC IV FLUIDS • What IV fluids are designed to stay in the intravascular space (intra, within; vascular, blood vessels) to increase the intravascular volume, or volume of circulating blood?

  28. ISOTONIC SOLUTIONS = 285-295 mOsm/L Na = 135-145meq/L • HYPERTONIC SOLUTIONS = > 300 mOsm/L Na = > 150meq/L • HYPOTONIC SOLUTIONS = < 260 mOsm/L Na < 130meq/L

  29. CRYSTALLOIDS • contain electrolytes (e.g., sodium, potassium, calcium, chloride) but lack the large proteins and molecules found in colloids. • classified according to their “tonicity.” • describes the concentration of electrolytes (solutes) dissolved in the water, as compared with that of body plasma (fluid surrounding the cells).

  30. COMPOSITION OF IV FLUIDS

  31. COLLOIDS • contain solutes in the form of large proteins or other similarly sized molecules. • Remain in the blood vessels for long periods of time and can significantly increase the intravascular volume (volume of blood).

  32. COLLOIDS/PLASMA EXPANDERS • Albumin = 1-2 kg/dose infused in 2 hours • Haes-teryl = 20-40ml/kg • Voluven = 20-40ml/kg • Gelofuschin = 20-40ml/kg • Fresh frozen plasma = 10-15ml/kg x 4 hours • Dextran 40 or 60

  33. BLOOD AND BLOOD PRODUCTS • are the most desirable fluids for replacement but are not the first choice for immediate volume expansion in children with shock • Not only is the intravascular volume increased, but the fluid administered can also transport oxygen to the cells.

  34. BLOOD AND BLOOD PRODUCTS

  35. Computation

  36. OVERALL GOALS

  37. STEP ONE: Estimate Losses

  38. STEP TWO: In shock?

  39. MACRODRIP SETS = 10 – 15 drops (gtts)/ml • MICRODRIP SETS= 60 microdrops (ugtts)/ml)

  40. (Volume in mL) x (drip set)    gtts ------------------------------------ = ------ (Time in minutes)    min

  41. CONVERSION FACTORS 1 ml = 15 drops (gtts) = 60 microdrops (ugtts) 1 drop (gtt) = 4 microdrops (ugtts) 1 microdrop (ugtts)/min = 1 ml/hour

  42. FLUID DEFICITSLudan’s Method

  43. FLUID DEFICITS – WHO*Use Ringer’s Lactate SOME DEHYDRATION 75ml/kg in 4 hours SEVERE DEHYDRATION

  44. SODIUM CORRECTION • DEFICIT CORRECTION: desired-actual x weight x 0.6 * Desired Na+ is 135-145 meq • MAINTENANCE COMPUTATION: maintenance x weight *Maintenance is 2-4meq/kg • COMPUTE FOR ACTUAL Na+ Neededto be incorporated in your IV FLUID = Maintence + Deficit *Give the First ½ in 8 hours then ¼ in each succeeding 8 hour shifts to complete your 24 hour correction

  45. POTASSIUM CORRECTION • COMPUTE FOR THE K+ REQUIREMENT = 2-4meq/kg/day • DETERMINE how much KCL you will be incorporating in your IV fluid to complete a 24 hour correction • Check IV fluid rate • *Maximum 40meq/Liter of KCL incorporation in IV Fluid • CHECK POTASSIUM INFUSION RATE (KIR) = meq of KCL x IV rate (ml/hour) x weight (maximum of 0.2meq/kg/hour)

  46. MAINTENANCE REQUIREMENTSHolliday-Segar Method

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