Download - Fluid and Electrolytes Theraphy
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Crystalloids
Ex: isotonic, hypotonic, hypertonic
Colloids
> Increase intravascular colloid osmotic
pressure.
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Hypotonic fluid
Isotonic fluid
osmolality: 240-340 mOsm/L
Ringers lactate, blood component
Hypertonic fluids
> osmolality: 340 mOsm/L
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Not true solutions
Blood products
Stabilized human serum
Human albumin
Plasma protein factor
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Resucitation fluid
Maintenance fluid
Replacement fluid
Total parental nutrition
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Resucitation fluid
Hypoxia, septicemia
Stabilized human serum
Fresh frozen plasma
Ringers lactate
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Maintenance fluid
Supplies H2O and electrolytes
Hypotonic solutions
0.45 % NaCl
5 % dextrose water
0.2 % NaCl
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Replacement fluid
Correct fluids and electrolytes balance
Contains 3x more Na than maintenance
fluids
2 types:
Half- strength Darrows Half- normal saline
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Total parentaral nutrition
Meet fluids electrolytes and nutritional
requirements
Pt with NGT
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Mild dehydration
thirsty, alert, restless
Estimated fluid deficit: 4-5 ml or 40-50 kg
Pinch retracts immediately
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Moderate dehydration
thirsty, restless, lethargic, irritable to touch
or drowsy, hypotension
6-9ml, 60-90 kg
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Severe dehydration:
Drowsy, cold sweaty, cyanotic
extremities; maybe comatose
Concious, apprehensive, wrinkled skin offingers and toes muscle cramps.
Pinch retracts: very slowly approximately72 secs.
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Extracellular volume deficit
Extracellular volume excess
Na deficit
Na excess
K deficit
K excess
Ca deficit
Ca excess
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Finding Possible cause
skin
Poor skin turgor Fluid volume defici
Cold clammy skin Na deficit
Pitting edema Fluid volume excess
Flushed, dry skin Na excess
Pulse
Bouncing Fluid volume excess
Rapid, weak, thready pulse Na deficit
Weak, irregular, rapid pulse Severe K deficit
Weak, irregular, slow pulse Severe K excess
Blood pressure
Hypotension Fluid volume deficit, Na deficit
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Hypertension Fluid volume excess,
Respiration
Deep, rapid breathing Matabolic acidosis
Shallow, slow irregular breathing Metabolic alkalosis
Shortness of breath, Moist crackles
skeletal muscle
Fluid volume excess
Cramping of exercised muscle Ca deficit
Carpal spasm ( trousseaus sign) Ca deficit
Flabby muscles K deficit
Positive Chvosteks sign Ca deficit
Behavioral of mental
Picking at bedclothes K and mg deficit
Indifference Fluid volume deficit, Na deficit
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Apprehension Shift of plasma to intersitial fluid
Extreme restlessness K excess, fluid volume deficit
Confusion K deficit, fluid volume excess