Pharm Fluids and electrolytes.

How much of the body is water?

approx 60%.

Movement of solution to balance concentration trough a membrane is called

Osmosis

Movement of Solutes to balance concentration is called

Diffusion

What is the main principle of Fluid therapy?

To correct fluid losses through dehydration and other things?

Physical and clinical findings to indicate giving fluids

Tacky dry MMs, slow skin tent, High PCV, TP, and USG.

<5% dehydrated

Not even detectable

5-6% dehydrated.

Slight loss of skin elasticity.

6-8% dehydrated

Noticeable delay of elasticity, slight increase CRT and dry MM

10-12%

Skin stays tented, greater increase in CRT, sunken eyes, tachycardia, weak pulse.

12-15% dehydrated

Prominent signs of shock and/or death.

How to calculate fluid deficit

% of dehydration X patients body weight in lbs or if in kg X 1,000ml/kg.

What is the maintenance fluid rate?

40-60ml/kg/day. But using 50 right in the middle,

What are ongoing fluid losses?

Fluid losses that are hard to measure from things like diarhhea, vomiting, respiration.

How to get ongoing losses.

You have to guess estimate.

How to get the final amount of total fluids needed for a patient

Hydration deficit + Maintenance, + Ongoing losses.

What is the preferred route of administration for fluids?

IV with severe losses, but can do SQ just takes longer.

Monitoring fluids

Checking body weight every 12 hours, urine, catheter, vomiting, diarrhea, TPR every 8 hours and PCV/TP every 24 hours.

Signs of overydrating

Restlessness, Watery nasal discharge, Tachycardia, Panting, Dyspnea, SubQ edema/swelling, Jello-like feel to SQ tissues.

Ideal supplies for setting up IV fluids

IV fluids pole, fluid bag (Or more than one), Fluid line warmer, fluid pump.

Types of fluid solutions

Crystalloids, colloids, hypertonic solutions, fluid additives, oral electrolytes, parenteral nutrition.

What are crystalloids?

Contain electrolyte and non-electrolyte substances that are capable of passing through cell membranes. Rapidly goes from vasculature to extravasculature.

What are crystalloids used for?

Corrects dehydration, shock, normal hydration, replacement of electrolytes and others.

Side effects of crystalloids

Overhydration.

2 main types of crystalloids

0.9% NaCl (normal saline), and LRS

0.9% NaCl

Normal saline. Increases plasma volume and corrects dehydration. Avoid in patients with heart disease!

Lactated Ringer’s Solution

Balanced electrolyte solution, very common. Contains lactate for liver to turn into bicarbonate to protect against acidosis. Do not give with blood products as calcium could form clots!!!

What are Colloids?

Contains large molecular weight particles that cannot cross the cell membrane. Stays in the vascular space and pulls more fluid into the vasculature.

What are Colloids used for?

Used for cerebral or pulmonary edema. Used in patients with hypovolemic or septic shock.

2 main Colloids

Dextrans and Hetastarch

Dextrans

Large molecular weight polysaccharide solution used for shock. But can cause allergic reactions or clotting deficits in some animals.

Hetastarch

Large molecular weight starch used for treating hypovolemia and hypoproteinemia. Expands plasma volume longer and has less side effects than Dextrans. But is costly.

Hypovolemia

Decrease of circulating blood in the body (fluid or cells)

Hypertonic solutions

Higher osmolality (particle concentration) than the tissues and causes fluid to move out of the tissue into the vasculature.

Hypertonic fluid uses

Used to treat hemorrhagic and endotoxic shock, major surgeries like GDV. Useful with brain or pulmonary edema. Used for shock associated with trauma, burns or pancreatitis.

What is the common hypertonic solution?

Hypertonic saline at 3,4,5,7, and 23.4%.

Side effects of hypertonic solutions

Vein or tissue irritation, re-hemorrhage in trauma patient, electrolyte imbalances. When administration ix too fast, hypertension, bronchoconstriction, and bradycardia.

What are fluid additive uses?

Correct acid-base abnormalities, electrolyte imbalances, supplement calories, and provide supplemental vitamins washed out by fluid therapy.

Common fluid additives

Potassium Chloride (KCl), Calcium, Dextrose, Vitamins,

Potassium Chloride (KCl) fluid additive

Used to supplement potassium deficits. Needs to be diluted!!

Common causes for hypokalemia

Anorexia, diuresis, and diarrhea.

Side effects of Hyperkalemia from giving too much

Muscle weakness and cardiact conduction disturbances.

Calcium supplements as fluid additives.

Needs to be diluted at least 1:1, corrects hypocalcemia. Calcium Gluconate and Calcium Chloride (10%) are common.

Calcium supplement side effects

Hypercalcemia that causes hypotension, cardiac arrhythmias and cardiac arrest. Usually if given too fast.

When is calcium given undiluted

In emergencies like eclampsia or milk fever. But only very slowly.

Dextrose 50% fluid additive.

Used to attempt to aid body in caloric need. Correct hypoglycemia from fever, sepsis, insulin overdose, insulinoma, or liver disease. Usually making a 2.5 or 5% solution.

Dextrose side effects

Few if given slowly and properly, but can cause some phlebitis if given too quick.

Vitamin supplements

Used when patient undergoes long periods of diuresis. Common is Vitamin B complex.

Vitamin supplements side effects

Hypersensitivity reactions to thiamine in complex.

Oral electrolyte preparations.

Used for more mild or moderate dehydration. Some gel or tablets. Side effects are rare unless it accidentally gets in respiratory.

Parenteral nutrition.

Nutrients given by non-GI route. Used when patient has had long term illness with caloric demand but no desire to eat. Often called Total Parenteral Nutrition. TPN.