Colloid solutions: 1

Gelatinous solutions containing particles suspended in solution.

These particles are largely unable to cross a semi-permeable membrane.
e.g. Albumin, Dextrans, Hydroxyethyl starch ,Haemaccel and
Gelofusine.

Crystalloid solutions:
Clear fluids made up of water and electrolyte solutions; will cross
a semi-permeable membrane.
e.g. Normal, hypo and hypertonic saline solutions, Dextrose
solutions; Ringer’s lactate and Hartmann’s solution.
Intravenous Fluid Therapy: 2

Indications:
 Coma, anaesthesia, Severe vomiting and diarrhoea,
 Dehydration and shock
 Hypoglycaemia
 Critical problems – anaphylaxis, status asthmaticus or epilepticus,
cardiac arrest , forced diuresis in drug overdose, poisoning.
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Properties Crystalloids Colloids

Intravascular Persistence Poor Good

Hemodynamic Stability Transient Prolonged

Required Infusion Volume Large Moderate

Risk of Tissue Edema Obvious Insignificant

Enhancement of capillary Poor Good

Risk of Anaphylaxis --------- Low to Moderate

Colloid Ontonic Pressure Reduced Maintained

Cost Inexpensive Expensive

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Crystalloids Colloids

Advantages Disadvantages Advantages Disadvantages

Cheep •Higher volume is Expansion •Expensive

Non allergic needed plasma volume far •Risk of Allergy
No infection superior •Coagulopathy
No interference •Relatively Short •May cause tissue
with Coagulation Amount of time May be salt edema
remaining sparing
intravascularn
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Types of Colloid Solutions:

Albumin
Dextrans
 Hydroxyethyl starch
Haemaccel
Gelofusine
Albumin: 8

Rate of infusion/Dosage:
• Adults – initial infusion of 25 gm
• 1 to 2 ml/min – 5% albumin
• 1 ml/min - 25% albumin

Mechanism of Action:
Replacement of plasma protein; increases intravascular oncotic
pressure, mobilizes fluids from interstitial into intravascular space

Metabolism:
Minimally in the liver,main site is unknown
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Indications :
• Plasma volume expansion in acute hypovolemic shock, burns, severe
hypo albuminemia
• Hypo proteinemia – liver disease, Diuretic resistant nephrotic
syndrome
• In therapeutic plasmapheresis , as an exchange fluid

Contra indications :
• Severe anaemia, cardiac failure
• Hypersensitive reaction
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Adverse Effects:
 Anaphylaxis
 CHF precipitation
 Edema
 Hypertension/hypotension
 Hypervolemia
 Tachycardia
 Decreased myocardial contractility
 Bronchospasm
 Pulmonary edema
 Salt and water retention
 Chills
Dextrans:
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Dosage Forms & Strengths

Inject able solution:
 6% (Dextran 70)
 10% (Dextran 40)

Indications :
• Hypovolemia correction
• Prophylaxis of DVT and post operative thromboembolism
• Improves blood flow and micro circulation in threatened vascular
gangrene
• Myocardial ischemia, cerebral ischemia, PVD and maintaining vacular
graft patency
• Priming in ECC
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Mechanism of Action
Branched polysaccharide volume expander through highly colloidal
starch structure; lowers platelet & RBC adhesiveness

Contraindications
Hypersensitivity to dextran or corn products
Pulmonary edema, severe bleeding disorders, severe CHF, severe
oliguria/anural due to renal disease, significant haemostatic defects,
cardiac decompensation
10%: Marked thrombocytopenia or hypofibrinogenemia
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Adverse effects:
 Frequency Not Defined
 Congestive heart failure
 Mild hypotension
 Tightness of chest
 Thrombocytopenia
 Anaphylaxis
 Injection site infection/phlebitis
 Acute renal failure
 Acidosis (if NaCl soln used)
 Pulmonary edema
 Wheezing
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Types of crystalloids:
 Normal, hypo and hypertonic saline solutions
 Dextrose solutions
 Ringer’s lactate
 Hartmann’s solution
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Normal saline
Indications:
 Water and salt depletion – diarrhoea, vomiting, excessive diuresis
 Hypovolemic shock
 Alkalosis with dehydration
 Severe salt depletion and hyponatremia
 Hypocalcaemia
 Irrigation – washing of body fluids
 Vehicle for certain drugs
Pharmacological basis : 16

 Provide major EC electrolytes.

 Corrects both water and electrolyte deficit.
 Increase the iv volume substantially
 An isotonic crystalloid volume expander that expands circulating blood
volume.
 It approximates the fluid and electrolyte composition of blood.

Contra indications:
 Avoid in pre eclamptic patients, CHF, renal disease and cirrhosis
 Dehydration with severe hypokalemia – deficit of IC potassium
 Large volume may lead to hyperchloremic acidosis
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Adverse Reactions:
 Cardiovascular:
Over hydration can increase workload of the heart and precipitate
congestive heart failure
 Respiratory:
Rapid breathing, pulmonary edema with overhydration
 Metabolic:
Fluid and electrolyte imbalances leading to muscle weakness if
used inappropriately.
 Ringer’s lactate : 18

Composition :
Na, k , Cl, lactate , ca
each 100 ml – sodium lactate 320 mg, NaCl -600mg, kcl-40mg,
calcium chloride 27 mg

Pharmacological basis :
• Most physiological fluid , rapidly expand s iv volume..
• Lactate metabolised in liver to bicarbonate providing buffering
capacity
• Acetate instead of lactate advantageous in severe shock.
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Indications:
• Correction in severe hypovolemia
• Replacing fluid in post op patients, burns
• Diarrhoea induced hypokalemic metabolic acidosis
• Fluid of choice in diarrhoea induced dehydration in paediatrics
• DKA , provides water, correct metabolic acidosis and supplies
potassium
• Maintaining normal ECF fluid and electrolyte balance
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Contra indications:
• Liver disease, severe hypoxia and shock
• Severe CHF , lactic acidosis takes place
• Addison’s disease
• Vomiting or NGT induced alkalosis
• Simultaneous infusion of RL and blood
• Certain drugs: amphotericin, thiopental, ampicillin, doxycycline
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