Fluids, Electrolytes, Buffers - Pulgar

it,,,,, it himb,,,,, :(

ICF

Intracellular fluid - Fluid IN the cells

EF

extracellular Fluid - water outside cells

2 components

IF 

Interstitial Fluid- fluid thats hanging out in tissues and around cells, but not within them

Part of the EF

Plasma 

The other half of EF - Fluid be here yo 

Capillary Exchange 

Net filtration occurs the aterial end of the capillary

Net Reabsorption happens near the venous end

No real pressure/movement in the middle of capillary

Fluid retention

Usually 

• Hypoalmbuminemia 

• Renal impairment 

• HF

• Hepatic Cirrhosis 

It can lead to Edema or Ascites

Common Dehydration sources

• V/D

• Hemorrhaging

• Sweat a lot

• diabetes Insipidus

• Diabetes

• Diuretic use

Common Symptoms of Dehydration 

• Muscle Cramps 

• Shrunken eyes 

• Hypotension 

• Viscous Blood 

• Hypoperfusion 

IV Fluids

Crystalloids

Colloids

Electrolyte Free

O2 Carrying

If you need over 1 L fluids you should use

Crystalloids

IV fluid therapy can consist of

Crystalloids, colloids, or a combo

Crystalloid solutions

Aqueous Ion solution that can come with or without glucose

Colloid Solutions 

High molecular weight substances like proteins or large glucose polymers 

Useful for rapidly increasing intravascular volume

Many types: Albumin, Dextran, Gelatin, Hydroxyethyl starches, Plasma Protein fraction

Colloids help __________ and for the most part remain intravascular; while Crystalloids ________ & distribute throughout the entire extracellular fluid space

Maintain plasma colloid oncotic pressure; rapidly equilibrate

Lactated Ringer’s

Isotonic crystalloid lots of Na, K, Ca, Cl, and Na Sodium Lactate in in sterile water

Very Useful in acidotic states 

Normal Saline 

0.9% NaCl in water 

Hypertonic Saline

3% NaCl in water

Half Normal Saline 

0.45% NaCl in water 

Quarter Normal Saline

0.22% NaCl with 5% Dextrose in water

IV Sugar solutions

5 or 10% Dextrose in saline or half normal saline

D5W

5% dextrose in water, aka sugar is the isotonic carbohydrate 

Useful for keeping a vein open by delivering a small amount of fluid over a long time 

Albumin solutions

Natural colloid

Indicated for emergency shock txt, acutely for burns, fluid resuscitation

Very expensive comparatively

Dextran

Highly branched polysaccharide, artificial

indicated for improving microcirculatory flow, eg decreasing blood viscosity & erythrocyte aggregation

Gelatin Solutions 

Proteins from boiled connective tissue 

Indicated for hypovolemia from acute blood loss, acute hemodilution, extracorporeal circulation 

Can cause coagulation abnormalities or have allergric responses but is cheap 

Hydroxyethyl starches

Synthetic volume expander used in shock

Can come as tetra, penta or hetra starch

Blood & Blood products

The most desirable replacement fluids if available, as tit can actually carry oxygen to cells

Can be Hb or Non Hb based

HB based Blood replacement (HBOCs) 

The different options are all based on the chemical modification of Hb, as they can cross link or polymerize or whatever to reach a new form of Hb - Each also helps with specific conditions 

Perfluorocarbons

The only non Hb oxygen carrying option- various chemical compounds

Fluosol is the main brand