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Lec 9 - electrolytes

Lec 9 - electrolytes

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Published by Eman Nazzal
Lec 9 - electrolytes
Lec 9 - electrolytes

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Published by: Eman Nazzal on May 06, 2013
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05/22/2013

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I.V fluids
The I.V fluids are manly two types:
 
1-colloids: which are almost like plasma in composition.2- crystalloids: which are only electrolytes.*and as a dentist you will use crystalloids, colloids are used in the hospitals more.
Crystalloids:
 
A. lactated Ringer's solution:
 composition
One liter of lactated Ringer's solution contains:-130 mEq of sodium ion = 130 mmol/L-109 mEq of chloride ion = 109 mmol/L-28 mEq of lactate = 28 mmol/L-4 mEq of potassium ion = 4 mmol/L-3 mEq of calcium ion = 1.5 mmol/L-Lactated Ringers has an osmolarity of 273 mOsm/Lthe PH of Lactated Ringers
in vitro ”outside the body” is acidic, but in vivo “inside the body” the
lactate will be converted to bicarbonate which is an alkaline, the Lactated Ringers is importantto maintain the PH of the blood (7.35-7.45), the blood is very sensitive for PH, that even a smallincreasing or decreasing in the PH level may be fatal (e.g. if the PH is 7.1 it is considered a severacidosis and the patent may die).*
What’s Osmolality?
 Term refers to the solute concentration in the body fluid by weight, the number of milliosmols(mOsm) in a kilogram (kg) of solution, in humans normally the osmolality in plasma is about275-295 mOsm/Kg , 90% of the osmolality depends on Na , and the other 10% depends onproteins and sugar.
B. Normal saline:
Simply salt water that contains only water, sodium and chloride, it is widely used, it is callednormal saline because it has the same osmolality of the plasma which is about (275-295mOsm/Kg).In the normal saline every one bag contains 1000ml, the sodium concentration is 0.9% which =(154 mEq/1000ml) ,and the same amount of chloride 0.9% (154 mEq/1000ml) the sum of (Na +
 
Cl¯= 308 mEq/1000ml) and it’s almost the same the concentration of sodium and chloride in the
plasma.
C. glucose solution (5% , 15% , 50%).
we have different concentration of glucose solutions , and you give the concentration accordingto the needs of the body . e.g 50% glucose solution it contains 500 gm of glucose , and every 1gm of glucose gives you 4 calories (500 ×4 = 2000 calories) and the daily need of calories 1800calories
*Why we have to use fluids??
 1. Maintenance: replaces normal ongoing losses2. Fluid Resuscitation: corrects any existing water and electrolyte deficits.
 
We measure the amount of fluids we need according to the body weight , for adults you need(30-50)ml\Kg \24H , for children for the first 10 kg 100ml\Kg\24h , for the second 10 kg youneed 50ml\Kg\24h and for more than 20 kg 25ml\kg\24h* If the patient have renal or heart disease (old age) you give him the minimum amount
“ia
. 30ml\Kg \24H
“to
avoid over loading on the heart or kidney
, but if the patient is young andhealthy you may use 50 ml\Kg \24H and his body can tolerate this amount of fluids e.g muadal zoubi.For the quantity You replace the same amount that the patient has lost , and about the quality
it’s according to other electrolytes mainly sodium Na
How much sodium & potassium do your body need per day ?(2 mEq\kg\24h) and you need half the amount of potassium (1 mEq\kg\24h)e.g if you have a 70 kg healthy patient how much electrolytes and how much liters do you givehim/her ?*(30-50)ml\Kg \24H
70 ×45 = 3.0 L \24h*(2 mEq\kg\24h)
70×2 = 140 mEq\24h sodium , and 70 ×1 = 70 mEq\24h potassiumso the patient need 3L of fluids and 140 mEq Na daily , and as you know 1L of normal saline orlactated Ringer's contains (154 mEq) sodium, so you give the patient 1L of normal saline orlactated Ringer's and the other 2L you give the patient electrolytes-free solution (e.g distilled
water 5% sugar and it’s only for quantity replacement . )
How can we calculate the daily deficit of fluids?

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