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PERIOPERATIVE FLUID AND ELECTROLYTE

MANAGEMENT







KASWIYAN




ANESTHESIOLOGY DEPARTMENT AND INTENSIVE CARE UNIT
FACULTY OF MEDICINE PADJADJARAN UNIVERSITY
HASAN SADIKIN GENERAL HOSPITAL
BANDUNG
2001
I. PHYSIOLOGY
TOTAL BODY FLUID
INTRACELLULAR
FLUID (ICF)
EXTRACELLULAR
FLUID (ECF)
TRANSCELLULAR
FLUID
30 40 % BW
INTRAVASCULAR
FLUID
INTERSTITIIL
FLUID
5 % BW 15 % BW
1-3 % BW
Blood plasma: 5% BW
Intracellular fluid: 40 % BW
Interstitiil fluid: 15 % BW
stomach
intestines
skin
kidney
lungs
TOTAL BODY FLUID
INTER COMPARTMENT BODY FLUID MOVEMENT

OSMOSIS: THE MOVEMENT OF THE MOLECULES (SOLVENT
MOLECULES) ACROSS A SEMIPERMEABLE MEMBRANE
(SELECTIVE PERMEABLE)

DIFFUSION: THE MOVEMENT OF THE MOLECULES ACROSS
PORES FROM HIGHER TO LOWER CONCENTRATION.
HYDROSTATIC PRESSURE OF THE BLOOD VESSELS PUSH
WATER TO DIFFUSE ACROSS THE PORES DIFFUSION
DEPEND ON CONCENTRATION AND HYDROSTATIC PRESSURE

GIBBS DONNAN EQUILIBRIUM: INTRACELLULAR FLUID
CONTAINS MORE ANIONIC PROTEIN COMPARE TO
INTERSTITIIL ONE HIGHER DIFFUSED CATIONS
(KALIUM, NATRIUM) AND LOWER DIFFUSED ANION
(CHLORIDE) MORE IONS DIFFUSE TO INTRACELLULAR
FLUID
STARLING FORCES: OSMOTIC PRESSURE 25 mmHg, END
CAPILLER VESSEL 35 mmHg, END VENOUS VESSEL 15 mmHg
WATER AND ELECTROLYTES DIFFUSE TO INTERSTITIIL FLUID
AT END CAPILLER AND 90 %ABSORBED AT END VENOUS
VESSEL.



SODIUM PUMP: IMBALANCE EXCHANGE (RATIO 3:2) BETWEEN
KALIUM AND NATRIUM IONS THROUGH SODIUM PUMP
MECHANISM AT CELLULAR MEMBRANE FACILITATED BY ATP


EQUILIBRIUM STATE
PERMEABLE MOLECULES, WATER

NON PERMEABLE MOLECULES
OSMOTIC
PRESSURE
OSMOSIS
BODY FLUID ELECTROLYTES

- NON IONS: DEXTROSE, UREUM, CREATININE
- IONS (SALTS):
CATIONS: Na
+
, K
+,
Ca
++,
Mg
++
ANIONS: HCO3
-
, Cl
-
, PHOSPHATE, PROTEIN,
ORGANIC ACID.

ELECTROLYTES AND PROTEIN OSMOTIC PRESSURE
DETERMINANT.









INTRACELLULAR
FLUID
EXTRACELLULAR
FLUID
MAIN
CATION
KALIUM (K
+
) NATRIUM (Na
+
)
MAIN
ANION
PHOSPHATE (PO4
-
) CHLORIDE (Cl
-
)
BODY FLUID REGULATION 2 MECHANISMS:


A. OSMOLAR:
- THE MOST EFFECTIVE AND DOMINANT
- THROUGH OSMORECEPTORS ANTIDIURETIC
HORMONE
- RENAL RECEPTORS RENIN ANGIOTENSIN -
ALDOSTERONE SYSTEM

B. NON - OSMOLAR:
- VOLUME RECEPTOR
- BARORECEPTOR AT CAROTID BODY AND ARCUS
AORTA
KIDNEY
JGA
ADRENAL
CORTEX
KIDNEY
TUBULES
OSMORECEPTORS
AND
POSTERIOR
PITUITARY
KIDNEY
TUBULES
LOW BLOOD
VOLUME
BLOOD VOLUME
INCREASE
WATER AND Na+ RETENTION
ADH
INCREASED Na +RETENTION
ALDOSTERONE
RENIN + ANGIOTENSINOGEN ANGIOTENSIN
JUXTAGLOMERULAR
APPARATUS
ANGIOTENSINOGEN
RENIN
ANGIOTENSIN I
ANGIOTENSIN II
ADRENAL CORTEX
ALDOSTERONE
CHANGES IN
SODIUM (AND WATER)
EXCRETION
EXTRACELLULAR FLUID
CHANGES
CONVERTING ENZYME
CHANGES
IN RENAL ARTERIAL
MEAN PRESSURE
THE RENIN ANGIOTENSIN SYSTEM
NORMAL WATER AND ELECTROLYTE EXCRETION:

- URINE : 700 1000 ml
- FAECES : 100 ml
- LUNGS : 400 ml
- SKIN : 500 ml

TOTAL: 1700 2000 ml
PERSPIRATIO INSENSIBILIS
INCREASED WATER EXCRETION:

-HYPERVENTILATION
-FEVER
-INCREASED ACTIVITY
-BURN
-DRY AND HEAT ATMOSPHERE
FLUID REQUIREMENT DAILY

1. ADULT:
- 2 3 L/24 hrs (100-125 ml/hr)
- 25 - 40 ml/kg BW/day
- INSENSIBLE LOSS; 1 L
- DIURESIS 1 ml/kgBW/hr
- 1,5 2 ml/kgBW/hr

2. INFANT AND CHILD:
- 1500 ml/m2 BSA/day
- BW < 10 kg = 100 ml/kgBW/day
10 20 kg = 1000 ml + 50 ml/kgBW/day
BW > 20 kg = 1500 ml + 25 ml/kgBW/day
EXAMPLE :

BW 75 kg = 700 ml/day
BW 15 kg = 1000 + 5 X 50 ml = 1250 ml/day
BW 24 kg = 1500 + 4 X 25 ml = 1600 ml/day

FORMULA 4-2-1:
BW 0-10 kg : 4 ml/kgBW/hr
BW 10 20 kg : 40 ml + 2 ml/kgBW/hr
BW 20-30 kg : 40 ml + 1 ml/kgBW/hr

CHILD : 2-4 ml/kgBW/hr
INFANT : 4-6 ml/kgBW/hr
NEONATE : 3 ml/kgBW/hr
ELECTROLYTES

A. NATRIUM (Na+):
- MAIN CATION IN EXTRACELLULAR FLUID
- PLAY AN IMPORTANT ROLE IN REGULATING
FLUID BALANCE
- PLASMA CONCENTRATION: 136 145 mEq/L
- REGULATION Na+ CONCENTRATION:
- LEFT ATRIAL STRETCH RECEPTORS
- CENTRAL BARORECEPTOR
- RENAL AFFERENT BARORECEPTORS
- ALDOSTERONE
- ATRIAL NATRIURETIC FACTOR
- RENIN-ANGIOTENSIN SYSTEM
- ADH SECRETION
- CHANGES IN TOTAL BODY WATER
B. KALIUM (K+)
- MAIN CATION (98%) IN INTRACELLULAR FLUID
- PLASMA CONCENTRATION: 3,5 5,0 mEq/L
- K+ BALANCE IS RELATED TO EXTRACELLULAR HYDROGEN
ION
- CAUSES OF HYPOKALEMIA:
- RENAL DISEASE: CHRONIC PYELONEPHRITIS
RENAL, TUBULER ACIDOSIS, DIURESIS PHASE OF
ACUTE TUBULER NECROSIS.
- DIABETIC ACIDOSIS
- METABOLIC ALCALOSIS
- INFANTILIS DIARRHEA
- DIURETIC THERAPY WITHOUT K+ SUPPLEMENT


C. CALCIUM

- SOURCE: FOOD, BEVERAGE, MAINLY MILK
- 80 - 90% EXCRETED VIA FAECES, 20% VIA URINE
DEPEND ON INTAKE, BONE SIZE AND ENDOCRINE STATE
- METABOLISM INFLUENCED BY PARATHYROID, THYROID,
TESTIS, OVARIUM AND HYPOPHYSEAL GLANDS


D. MAGNESIUM
- SOURCE: ALL KINDS OF FOOD
- REQUIREMENT 10 mg DAILY
- EXCRETED VIA FAECES AND URINE









E. PHOSPHOR
- SOURCE: ALL KINDS OF FOOD
- CALCIUM REQUIREMENT EQUAL OR MORE THAN
PHOSPHOR
- EXCRETED VIA URINE AND FAECES
- IN THE FORM OF PO4-, IT IS THE MAIN ANION IN INTRA
CELLULAR FLUID

F. CARBONAT
- CARBONIC ACID AND CARBOHYDRATE NET RESULT
OF METABOLISM
- BICARBONAT CONCENTRATION CONTROLLED BY KIDNEY
- CARBONIC ACID CONTROLLED BY LUNGS
SURGICAL TRAUMA
NEUROGENICAFFERENT
PSYCHOLOGIC
STIMULUS
HYPOTHALAMUS
PITUITARY
POSTERIOR
CORTICOTROPIN
RELEASING FACTOR
ADH PITUITARY ANTERIOR
SYMPHATETIC
ACTIVITY
ACTH
GROWTH HORMONE
PANCREAS
CORTEX ADRENAL
MEDULLA ADRENAL
CORTISOL ALDOSTERONE CATECHOLAMINE GLUCAGON
RENIN RELEASED
RENAL JUXTA
GLOMERULAR APPARATUS
ANGIOTENSINOGEN
LOW BLOOD VOLUME
BLOOD LOSS
ANGIOTENSIN
CORTEX ADRENAL
ALDOSTERONE RELEASED
Na+ RETENTION
BLOOD VOLUME INCREASED
H2O RETENTION
ADH RELEASED
OSMORECEPTOR
(SUPRA OPTIC NUCLEUS
OF HYPOTHALAMUS)
II. PATOPHYSIOLOGY

A. TRAUMA/SURGERY:
- CELL INJURY AT THE SITE OF SURGERY/TRAUMA
- LOSS OR TRANSLOCATION OF FLUID
- EFFECT OF NPO PRE, DURING AND POST SURGERY
- INCREASED METABOLIC STATE, TISSUE DAMAGE,
AND RECOVERY PERIOD
- HORMONAL CHANGES
- INCREASED ADRENALINE AND NOR ADRENALINE
TILL THE 3
rd
DAY
- INCREASED PLASMA GLUCAGON
- INCREASED GROWTH HORMONE
- INCREASED ACTH
- INCREASED PROLACTINE (MAINLY WOMAN)
FACTORS CONTRIBUTE TO THE CHANGES:

- PAIN AND ANALGETIC QUALITY
- FEAR AND SEDATION
- COMPLICATION AFTER SURGERY, e.g.: SHOCK, MASSIVE
BLEEDING, HYPOXIA AND SEPSIS
- GENERAL STATE OF THE PATIENT
- THE DEGREE OF TRAUMA
B. EFFECTS OF ANESTHETIC AGENTS AND TECHNIQUE

- REGIONAL ANESTHESIA VASODILATATION AND
HYPOTENSION
- BAROREFLEXES MORE SENSITIVE
- DECREASED CARDIAC OUTPUT, GLOMERULAR FILTRATION
RATE, RENAL BLOOD FLOW AND PERIPHERAL VASCULAR
RESISTANCE.
- HYPERVENTILATION RELATIVE HIPOKALEMIA
- MECHANICAL VENTILATION (CPAP) ATRIAL NATRI
URETIC FACTOR WATER AND NATRIUM EXCRETION

III. BASIC PRINCIPLES OF FLUID AND
ELECTROLYTES THERAPY

A. DAILY NORMAL REQUIREMENT OF FLUID AND
ELECTROLYTES
- ADULT: 30 35 ml/kgBW/day, Na+ 1-2 mmol/kgBW/day,
K+ 1 mmol/kgBW/day
- INFANT AND CHILD:
BODY WEIGHT FLUID REQUIREMENT
PER HOUR
0 10 kg 4 ml/kgBW/hr
10 20 kg 40 + 2 ml/kgBW/hr over
10 kg
> 20 kg 60 + 1 ml/kgBW/hr over
20 kg
B. FLUID AND ELECTROLYTE DEFISIT BEFORE SURGERY
- NPO 6 12 HOURS
- INSENSIBLE LOSS CAUSED BY FEVER, HYPERVENTILATION,
AND PERSPIRATION.


C. FLUID LOSS DURING SURGERY
- BLEEDING
- OTHER FLUID LOSS
- EVAPORATION
- FLUID TRANSLOCATION / SEQUESTRATION

D. RENAL DISFUNCTION
- DECREASE GFR
- INCREASE ADH
IV. MANAGEMENT

A. DEFISIT REPLACEMENT BEFORE SURGERY
- NPO, LAVEMENT
- FLUID MAINTENANCE:








- BLEEDING, FLUID LOSS (THROUGH GI TRACT)


AGE TOTAL REQUIREMENT
(ml/kgBW/hr)
ADULT 1,5 2
CHILD 2 4
INFANT 4 6
NEONATE 3
CLASS I II III IV
BLOOD LOSS (ml) <750 750 - 1500 1500 - 2000 > 2000
BLOOD LOSS (% EBV) < 15% 15 30 % 30 40 % > 40%
PULSE (x/mnt) < 100 > 100 > 120 weak
BLOOD PRESSURE N / N /

CAPILLARY REFILL N + + +
RESPIRATORY RATE 14 - 20 20 30 30 - 40 > 40
DIURESIS (ml/hr) >30 20 - 30 10 20 0 10
MENTAL STATUS N/restless restless/anxi
ety
somnolence somnolence/c
oma
FLUID THERAPY Crystalloid/
RL 2,5 L or
Colloid 1 L
Crystalloid/
RL+Colloid
1 L
Crystalloid+
blood/RL
1 L+Colloid 0,5
L+Blood 1-1,5 L
or PRC 0,5-
0,75 L
Crystalloid+
Blood/RL
1 L+Colloid
1 L+Blood
2 L or PRC
1 L+Colloid
1 L
CLASSIFICATION OF ACUTE BLOOD LOSS
CLINICAL SIGNS DEGREE FLUID
DEFICIT
I - SKIN TURGOR
-TACHYCARDIA
-THIRSTY, DRY TONGUE
MILD 3 5 % BW
II - SKIN TURGOR
- TACHYCARDIA, WEAK PULSE
- THIRSTY, WRINKLED TONGUE
MODERATE 5 10 % BW
III - SKIN TURGOR
- WEAK PULSE, ALMOST NOT PALPABLE
- SEVERE HYPOTENSION
- SUNKEN EYES, WRINKLED TONGUE
- CYANOTIC ACRAL
- STUPOR, COMA, SHOCK
-MARKED DEPRESSED ANTERIOR
FONTANELLA
SEVERE > 10 % BW
SYMPTOMS AND DEGREE OF DEHYDRATION
THERAPY

- PRIMARY DEFISIT FROM EXTRACELLULER FLUID
- FLUID: RL or NaCl 0,9% 20 40 ml/kgBW in 1 2 hrs, REPEATED IF
SHOCK IS PERSISTENT.
- EVALUATION:
- IMPROVEMENT IN HAEMODYNAMIC (BLOOD PRESSURE
AND PULSE RATE)
- IMPROVEMENT IN PERIPHERAL PERFUSION (WARM AND
PINK).
- CENTRAL VENOUS PRESSURE
- URINE 0,5 1 ml/kgBW/hr
B. FLUID EXCESS BEFORE SURGERY

WATER EXCESS:

ETIOLOGY:
-PATHOLOGIC HYPERDYPSIA
-THERAPY DEXTROSE OR NaCl 0,45 % FOR FLUID REPLACEMENT
-ABSORPTION OF IRIGATING FLUID IN TURP
-FORCED DIURESIS WITHOUT FLUID REPLACEMENT
CONTAINING Na+

SYMPTOMS:
-CEREBRAL OEDEM
-ELEVATION OF INTRA CRANIAL PRESSURE
-RESTLESSNESS, HEADACHE, CONVULSION, COMA
HYPERVOLUMI

SENSITIVE TO VOLUME OVERLOAD:
- HEART FAILURE, RENAL FAILURE
- OVER SECRETION OF ADRENOCORTICAL HORMONE
- OVER FLUID THERAPY, MAINLY ISOTONIC FLUID

SYMPTOMS:
-PULMONARY HYPERTENSION, DYSPNOE, CYANOSIS,
COUGH
-SIGNS OF INCREASED PCWP
-ASCITES, PLEURAL EFFUSION, PERIPHERAL OEDEM
-DILATATION OF LARGE VEINS
-ELEVATION OF CVP AND BLOOD PRESSURE
ELECTROLYTE DISTURBANCE BEFORE SURGERY

A. HYPONATREMIA

ETIOLOGI:
- AQUADEST DIFFUSION POST TURP
- EXTRACELLULER FLUID DEFISIT, CAUSED BY PERITONITIS,
DIARE, GIVEN DEXTROSE OR NaCl 0,45% ONLY
- FORCED DIURETIC THERAPY

SYMPTOMS:
- CONSCIOUSNESS DIMINUTION, CONVULSION, BLOOD
PRESSURE ELEVATION, DECREASED PULSE RATE
BRAIN DAMAGE, CEREBRAL SYMPTOMS



B. HYPERNATREMI

FLUID LOSS WITHOUT NATRIUM LOSS, eg. HIGH FEVER FOR A
LONG PERIOD

SYMPTOMS:
- THIRSTY, DECREASE BLOOD PRESSURE, CONSCIOUSNESS
DISTURBANCE


C. HYPOKALEMI

FLUID LOSS FROM GI TRACT, DIURETIC USAGE FOR A LONG
PERIOD, STENOSIS, NPO MORE THAN 5 DAYS IN KETO
ACIDOSIS

SYMPTOMS:
-MUSCLE WEAKNESS, PARALITIC ILEUS, ARITMIA, MORE
SENSITIVE TO DIGITALIS, CARDIAC ARREST




D. HYPERKALEMI

CAUSE:
RENAL DISFUNCTION, ACIDOSIS, MASSIVE TRANSFUSION,
TISSUE DAMAGE (COMBUSTIO)

SYMPTOMS:
CARDIAC ARITMIA, VENTRICLE FIBRILLATION (PLASMA
KALIUM MORE THAN 7 mEq/L)

E. HYPOCALCEMI

CAUSE:
HYPOPARATHYROID STATE WITH CO-EXISTING SEPSIS, RENAL
FAILURE, HYPOALBUMINEMIA.

SYMPTOMS:
TETANY, MYOCARDIAL DISTURBANCE

F. HYPERCALCEMIA
SYMPTOMS: MUSCLE WEAKNESS, COMA
FLUID MANAGEMENT DURING SURGERY

FLUID REPLACEMENT = DAILY REQUIREMENT + FLUID
LOSS CAUSED BY SURGERY
- MINOR SURGERY e.g OPTHALMIC SURGERY (CATARACT
EXTRACTION) MAINTENANCE FLUID
- SURGERY WITH MINIMAL TRAUMA e.g. APPENDICTOMY
2 ml/kgBW/hr + 4 ml/kgBW/hr FOR FLUID
REPLACEMENT CAUSED BY SURGERY
- SURGERY WITH MODERATE TRAUMA 2 ml/kgBW/hr
+ 6 ml/kgBW/hr
- SURGERY WITH SEVERE TRAUMA 2 ml/kgBW/hr +
8 ml/kgBW/hr
- BLOOD LOSS REPLACEMENT: WITH CRYSTALLOID 3 X BLOOD
LOSS OR COLLOID 1 X BLOOD LOSS
FLUID SHIFT OPERATION RATES
(CRYSTALLOID)
MINOR TENDON REPAIR, TYMPANOPLASTY 0 3 ml/kgBW/hr
MODERATE HYSTERECTOMY, INGUINAL
HERNIA
6 ml/kgBW/hr
MAYOR TOTAL HIP REPLACEMENT,
ABDOMINAL CASE WITH
PERITONITIS
9 ml/kg BW/hr
RATES OF FLUID ADMINISTRATION TO REPLACE
THIRD SPACES LOSSES
AGE BLOOD VOLUME
NEONATES
- PREMATURE
- FULL-TERM
INFANT
ADULT
- MALE
- FEMALE

95 ml/kg BW
85 ml/kgBW
80 ml/kgBW

75ml/kgBW
65 ml/kgBW
ESTIMATED BLOOD VOLUME
BLOOD TRANSFUSION:

GENERAL CONSIDERATION:

- 1 UNIT PACKED RED CELL INCREASE Hb LEVEL UP TO 1 gr%
AND HEMATOCRIT UP TO 2 - 3% (ADULT)
- TRANSFUSE PRC 10 ml/kgBW INCREASE Hb LEVEL 3 gr%
- MONITOR VITAL SIGNS AND DIURESIS (1ml/kgBW/hr)

POST OPERATIVE FLUID AND ELECTROLYTE MANAGEMENT

GOALS:

- TO PROVIDE DAILY REQUIREMENT OF WATER, ELECTROLYTE AND
CALORI / NUTRITION
- FLUID REPLACEMENT:
-FEVER
-GASTRIC FLUID LOSS VIA NGT OR VOMITING
-HYPERVENTILATION OR TRACHEOSTOMY WITHOUT
HUMIDIFICATION
- TO CONTINUE REPLACE FLUID DEFISIT DURING SURGERY
- CORRECTION OF ELECTROLYTE / FLUID IMBALANCE
URINE VOLUME 1500 ml
SPECIFIC GRAVITY OF URINE 1,015
AMOUNT OF PLASMA
PROTEIN
MORE THAN 6,5 gr/dl
AMOUNT OF Hb More than 12 gr/dl
HEMATOCRIT VALUE 40 %
OTHERS CORRECTION OF ELECTROLYTE
IMBALANCE, PERIPHERAL
BLOOD FLOW, ALTERATION TO
POSITIVE NITROGEN BALANCE,
RECOVERY OF BODY WEIGHT,
RECOVERY OF NORMAL BODY
TEMPERATURE, HEART RATE
AND GENERAL CONDITION
CRITERIA TO COMMENCE INFUSION THERAPY
INTRAVENOUS FLUIDS
A. CRYSTALLOIDS:
- COMPOSITION: SIMILAR TO EXTRACELLULAR FLUID
- INEXPENSIVE, AVAILABLE, NO CROSS MATCH, NO
ALLERGIC / ANAPHILACTIC REACTION, SIMPLE STORAGE
- AS EFFECTIVE AS COLLOID IN APPROPIATE AMOUNT
- HALF LIFE IN INTRAVASCULAR SPACE: 20 30 MINUTES
Solution Tonicity Na+
(mEq/L)
Cl-
(mEq/L)
K+
(mEq/L)
Ca2+(mE
q/L)
Glucose
(g/L)
Lactate
(mEq/L)
5%
Dextrose
in water
(D5W)
Hypo
(253)
50
Normal
Saline
Iso (308) 154 154
D5 NS Iso (330) 38,5 38,5 50
D5 NS Hyper
(407)
77 77 50
D5 NS Hyper
(561)
154 154 50
RL Isi 273) 130 109 4 3 28
D5 RL Hyper
(525)
130 109 4 3 50 28
COMPOSITION OF CRYSTALLOID
Crystalloid Colloid
Advantages - Inexpensive
- Promotes urinary
flow
- Fluid of choice for
initial resuscitation
of
trauma/hemorrhage
- Expands
intravascular volume
- Restores 3
rd
spaces
losses
-More sustained intravascular
-Volume increase (1/3 still intravascular at 24 hrs)
- Maintain or increase plasma oncotic pressure
-Requires smaller volume for equal effects
-Less peripheral oedem (more fluids remains
intravascular)
-May lower intracranial pressure
Disadvantages - Dilutes colloid
osmotic pressure
- Promotes peripheral
oedem
- Higher incidence of
pulmpnary oedem
- Requires large
volume
- Effects are transient
-Expensive
-May produce coagulopathy (dextrans and
hetastarch)
-With capillary leaks may potentiate fluid loss to
the interstitium
-Impairs subsequent crossmatching of blood
(dextran)
-Dilutes clotting factors and platelet
-Decrease platelet adhesiveness (absorption onto
platelet membrane reseptor)
-Potential blocking of renal tubules and
reticuloendothelial cells in the liver
-Possible anaphylactoid reaction with dextran
CRYSTALLOID VS COLLOID
B. COLLOIDS

- NATURAL COLLOIDS:
-PLASMA PROTEIN FRACTION 5%
-HUMAN ALBUMIN 5% AND 2,5%

- SYNTHETIC COLLOIDS
- DEXTRAN 40 AND 70
- HYDROXYETHYL STARCH (HETASTARCH) 6% AND
10 %
-GELATIN
-MODIFIED FLUID GELATIN
-UREA LINKED GELATIN
-OXYPOLY GELATIN
Colloids Production Type Molcular
Weight
(10
3
)
Halflife
intravascul
er
Indication
Plasma
protein
Human plasma Serum
human
albumin
50 4-15 days -Volume substitute
- Hypoprotein
emia
- Hemodilution
Dextran Leuconostoc
mesenteroid B 512
D 40, 70 60-70 6 hrs -Hemodilution
-Microcirculation
disturbance
Gelatine Hydrolisis animal
collagen

- Modified
gelatine
-Urea linked
- Oxypoly
gelatine
35 2-3 hrs -Volume substitute
Starch Acid hydrolisis and
ethylene oxide
from soybeans and
maize
- Hydroxi
ethylstarch
450 6 hrs -Volume substitute
-Hemodilution
Polyvinyl
pyrrolido
ne (PVC)
Polymer synthetic
vynil pyrrolidone
- Subtosan
--Peristone
50
25
-Volume substitute