Public Health Pharmacy

(PHP)
Presentation on
Fluid Replacement Therapy

Prepared by:-
Sukesh Kumar Yadav
Roll No.:-28
ACAS, B.Pharmacy
Fluid Replacement Therapy
 Fluid replacement therapy is the process in which the body fluids is replaces that is
lost through diarrhea, vomiting, sweating, bleeding and pathogenic process.
 The fluid replacement in the body during dehydration is various ways and routes:
1. Oral rehydration therapy
2. Intravenous therapy
3. Nasogastric therapy

Oral rehydration therapy

 The oral rehydration therapy (ORT) is a type of fluid used to prevent and treatment
of dehydration especially that due to diarrhea.
 It involves drinking water with modest amount of sugar and salt added (oral
rehydration salt or ORS) while continuing to drink.
 The routine therapy also includes supplemental zinc.
 If the person vomits, the World Health Organization (WHO) recommends taking a
pause of five to ten minute and then restarting the solution more slowly.
Composition of Oral Rehydration salt (ORS)
WHO standard formula (Old)
 NaCl : = 3.5 g
 KCl: = 1.5g
 Trisodium citrate: = 2.9gm
 Glucose: = 20g

WHO standard formula (New)

 NaCl = 2.6 g
 KCl = 1.5g
 Trisodium citrate = 2.9gm
 Glucose = 13.5g

(The contents are dissolved in 1 liter of fresh drinking water and should be use within 24 hours)
Important functions served by electrolytes
1. sodium (Na+) – Mainly responsible for regulating the total amount of water in the body.
2. potassium (K+) – Essential to regulating heartbeat and muscle function.
3. chloride (Cl–) – Aids sodium in maintaining a proper balance of fluids throughout the
body.
4. calcium (Ca2+) – In addition to being essential for strong, healthy bones; calcium also
helps transmission of blood clot, nerve impulses and muscle contraction.
5. magnesium (Mg2+) – Regulates heart rate, immune system, nerve function, muscle
function, stabilizes blood sugar, and promotes the creation of bones and teeth.
6. bicarbonate (HCO3–) – Help maintain pH levels; thus counteracts lactic acid buildup in
your muscles during strenuous workouts.
7. phosphate (PO42-) – Works with calcium to maintain strong, healthy bones and
contributes to energy production in the cells (i.e., helps with muscle growth & recovery).
Intravenous therapy
 Intravenous therapy (IV therapy) is the infusion of liquid substances directly into a
vein and it is especially designed for administration of drugs.
 Intravenous therapy may be used to correct electrolyte imbalance, to deliver
medications, for blood transfusion or fluid replacement to correct dehydration.
(Colloids or crystalloids are also use through IV therapy.)
The types of IV fluids include:
 Isotonic Solutions:- Isotonic solutions are IV fluids that have a similar
concentration of dissolved particles as blood.
 Hypotonic Solutions:- Hypotonic solutions have a lower concentration of
dissolved solutes than blood.
 Hypertonic Solutions:- Hypertonic solutions have a higher concentration of
dissolved solutes than blood.
Normal Saline (NS)
 ​Normal saline is a mixture of salt and water.
 It is called normal because its salt concentration is similar to tears, blood and other
body fluids (0.9% saline).
 It is also called isotonic solution.
 Normal Saline may be used alone or with other medications.
 Normal Saline belongs to a class of drugs called Crystalloid Fluid and also uses as
plasma volume expander which enhance circulating blood volume.

 Composition : 0.9% Nacl (0.9 gm Nacl in 100 ml of water)

Colloids or crystalloids for fluid replacement :
 To assess the effect of using colloids versus crystalloids in critically ill people
requiring fluid volume replacement on mortality, need for blood transfusion
or renal replacement therapy (RRT), and adverse events (specifically:
allergic reactions, itching, rashes).

 Crystalloids have small molecules, are cheap, easy to use, and provide
immediate fluid resuscitation, but may increase oedema.
E.g. normal saline, dextrose, Ringer’s solution etc.

 Colloids have larger molecules, cost more, and may provide swifter volume
expansion in the intravascular space, but may induce allergic reactions,
blood clotting disorders, and kidney failure.
E.g. dextran, human albumin, gelatin, blood. Blood itself is a colloid.
Colloids or crystalloids for fluid replacement in critically people
 Critically ill people may lose large amounts of blood (because of trauma or burns),
or have serious conditions or infections (e.g. sepsis); they require additional fluids
urgently to prevent dehydration or kidney failure. Colloids and crystalloids are
types of fluids that are used for fluid replacement, often intravenously (via a tube
straight into the blood).
 Crystalloids are low‐cost salt solutions (e.g. saline) with small molecules, which
can move around easily when injected into the body.
 Colloids can be man‐made (e.g. starches, dextrans or gelatins), or naturally
occurring (e.g. albumin or fresh frozen plasma (FFP)), and have bigger molecules,
so stay in the blood for longer before passing to other parts of the body. Colloids
are more expensive than crystalloids. We are uncertain whether they are better
than crystalloids at reducing death, need for blood transfusion or need for renal
replacement therapy (filtering the blood, with or without dialysis machines, if
kidneys fail) when given to critically ill people who need fluid replacement.
Nasogastric feeding
 It is administration of food directly into the stomach using a tube passed into the
stomach through the nose or mouth.
 Breast milk, liquid food and formula give through the tube directly into the stomach.

Purposes:
 It provide nutrients to patients that can’t eat through mouth.
 To administration medication.
 To give large amount of fluids for therapeutics purposes.
Indications:
 Unconscious or semi-conscious patents.
 After certain surgery for mouth and throat.
 Patent unable to swallows.
 Premature babies.
 Recurrent episodes of an aspirations.
 Poor oral intake patents.
 The patents that requires high metabolic needs.
e.g.- burn, cancer, etc
References
1. Principle of anatomy and physiology ;By C.K. Singh
2. Images from internet (Medwik.in)
3. Additional sources - Internet