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IV FLUID THERAPY

. Principles • Maintenance therapy replaces normal ongoing losses • Replacement therapy replaces and corrects existing water and electrolytes deficits • Volume resuscitation • Fluid replacement should be as close as possible in volume and composition to the fluids lost • Acute losses should be replaced quickly • Chronic losses. Be careful not to overload – Do not overload with Na .

burns . 10% higher fluid requirement – Gut losses . diuretics . diarrhea. 1 degree rise. Abnormal fluid losses • Normal loss of Na & K. 1mmol/kg/hr • Loss of water. vomiting – Renal losses. hyperglycemia – Trauma. 1 ml/kg/hr • Abnormal losses – Increased sweating – Fever.

Types of Fluids • Crystalloid • Colloid • Blood products • Isotonic • Hypotonic • Hypertonic .

Colloids • Solution that contains large molecules that do not pass the cell membrane • When infused. remains in intravascular compartment. expands intravascular volume draws fluid from extravascular spaces because of their higher oncotic pressure .

Crystalloids • Solutions that contain small molecules that flow easily across cell membranes • Will increase fluid volume in intravascular and interstitial space • Can be subdivided – Isotonic – Hypertonic – hypotonic .

Isotonic Solutions • Solution has the same tonicity / osmolality / solute concentration as normal plasma and other body fluids • Maintains body fluid balance • Expands intravascular fluid compartment • Does not effect size of the cells .

Hypotonic Solution • Has a lower tonicity / osmolality than plasma • Solution causes a fluid shifts into interstitial space and into the cells .

Hypertonic Solutions • Solution has a tonicity / osmolality higher than plasma • Pulls fluid out from the cells .

350:bmj. Fig 1 Body fluid compartment volumes and theoretical distribution of intravenous fluids in healthy people .g7620 ©2015 by British Medical Journal Publishing Group . Paul Frost BMJ 2015.

Distribution of 1L IV fluids • IC EV IV • D5 666 249 83 • Crystolloids 0 750 250 – Isotonic 0.9% NaCl • Colloids – Immediate 0 0 1000 .