PERIOPERATIVE FLUID AND ELECTROLYTE

MANAGEMENT

ENDANG MELATI MAAS

DEPARTMENT OF ANESTHESIOLOGY & REANIMATION

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY
Dr. MUHAMMAD HOESIN GENERAL HOSPITAL
PALEMBANG
I. PHYSIOLOGY

TOTAL BODY FLUID

INTRACELLULAR EXTRACELLULAR TRANSCELLULAR

TRANSCELLULAR
INTRACELLULAR
FLUID(ICF)
(ICF) FLUID (ECF) FLUID
FLUID
FLUID
30 – 40 % BW 1-3 % BW

INTRAVASCULAR
INTRAVASCULAR INTERSTITIIL
INTERSTITIIL
FLUID
FLUID FLUID
FLUID

5 % BW 15 % BW
 TOTAL BODY FLUID
stomach
intestines
lungs skin
Blood plasma: 5% BW kidney
fluid: 20 % BW
Extracellular

Interstitiil fluid: 15 % BW

Intracellular fluid: 40 % BW
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
 OSMOSIS
OSMOTIC
PRESSURE

PERMEABLE MOLECULES, WATER EQUILIBRIUM STATE

NON PERMEABLE MOLECULES

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 EXTRACELLULAR
FLUID FLUID
MAIN KALIUM (K+) NATRIUM (Na+)
CATION
MAIN PHOSPHATE (PO4-) CHLORIDE (Cl-)
ANION
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
ANGIOTENSIN
JGA RENIN + ANGIOTENSINOGEN

LOW BLOOD
ADRENAL
VOLUME
CORTEX
ALDOSTERONE

BLOOD VOLUME KIDNEY

INCREASE TUBULES

INCREASED Na +RETENTION
WATER AND Na+ RETENTION

OSMORECEPTORS
KIDNEY AND
TUBULES POSTERIOR
ADH PITUITARY
 THE RENIN ANGIOTENSIN SYSTEM

JUXTAGLOMERULAR CHANGES
APPARATUS IN RENAL ARTERIAL
MEAN PRESSURE
RENIN

ANGIOTENSINOGEN EXTRACELLULAR FLUID

CHANGES

ANGIOTENSIN I

CONVERTING ENZYME

ANGIOTENSIN II

ALDOSTERONE
CHANGES IN
ADRENAL CORTEX SODIUM (AND WATER)
EXCRETION
NORMAL WATER AND ELECTROLYTE EXCRETION:

- URINE : 700 – 1000 ml

- FAECES : 100 ml
- LUNGS : 400 ml
PERSPIRATIO INSENSIBILIS
- SKIN : 500 ml

TOTAL: 1700 – 2000 ml

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 HYPOTHALAMUS
STIMULUS

PITUITARY
POSTERIOR CORTICOTROPIN
RELEASING FACTOR

SYMPHATETIC
ADH PITUITARY ANTERIOR ACTIVITY

ACTH
GROWTH HORMONE

MEDULLA ADRENAL PANCREAS

CORTEX ADRENAL

CORTISOL ALDOSTERONE CATECHOLAMINE GLUCAGON

 RENIN RELEASED
RENAL JUXTA
GLOMERULAR APPARATUS
ANGIOTENSINOGEN

LOW BLOOD VOLUME

ANGIOTENSIN

BLOOD LOSS
CORTEX ADRENAL
BLOOD VOLUME INCREASED

ALDOSTERONE RELEASED
H2O RETENTION

Na+ 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 3rd 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:

AGE TOTAL REQUIREMENT

(ml/kgBW/hr)
ADULT 1,5 – 2
CHILD 2–4
INFANT 4–6
NEONATE 3

- BLEEDING, FLUID LOSS (THROUGH GI TRACT)

 CLASSIFICATION OF ACUTE BLOOD LOSS
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 somnolence somnolence/c
ety oma
FLUID THERAPY Crystalloid/ Crystalloid/ Crystalloid+ Crystalloid+
RL 2,5 L or RL+Colloid blood/RL Blood/RL
Colloid 1 L 1L
1 L+Colloid 0,5 1 L+Colloid
L+Blood 1-1,5 L 1 L+Blood
or PRC 0,5-
2 L or PRC
0,75 L 1 L+Colloid
1L
 SYMPTOMS AND DEGREE OF DEHYDRATION
CLINICAL SIGNS DEGREE FLUID
DEFICIT

I - SKIN TURGOR MILD 3 – 5 % BW

-TACHYCARDIA
-THIRSTY, DRY TONGUE
II - SKIN TURGOR MODERATE 5 – 10 % BW
- TACHYCARDIA, WEAK PULSE
- THIRSTY, WRINKLED TONGUE
III - SKIN TURGOR SEVERE > 10 % BW
- WEAK PULSE, ALMOST NOT PALPABLE
- SEVERE HYPOTENSION
- SUNKEN EYES, WRINKLED TONGUE
- CYANOTIC ACRAL
- STUPOR, COMA, SHOCK
-MARKED DEPRESSED ANTERIOR
FONTANELLA
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
 RATES OF FLUID ADMINISTRATION TO REPLACE
THIRD SPACES LOSSES
FLUID SHIFT OPERATION RATES
(CRYSTALLOID)
MINOR TENDON REPAIR, TYMPANOPLASTY 0 – 3 ml/kgBW/hr

MODERATE HYSTERECTOMY, INGUINAL 6 ml/kgBW/hr

HERNIA
MAYOR TOTAL HIP REPLACEMENT, 9 ml/kg BW/hr
ABDOMINAL CASE WITH
PERITONITIS

ESTIMATED BLOOD VOLUME

AGE BLOOD VOLUME
NEONATES
- PREMATURE 95 ml/kg BW
- FULL-TERM 85 ml/kgBW
INFANT 80 ml/kgBW
ADULT
- MALE 75ml/kgBW
- FEMALE 65 ml/kgBW
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
 CRITERIA TO COMMENCE INFUSION THERAPY

URINE VOLUME 1500 ml

SPECIFIC GRAVITY OF URINE 1,015
AMOUNT OF PLASMA MORE THAN 6,5 gr/dl
PROTEIN
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
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

 COMPOSITION OF CRYSTALLOID
Solution Tonicity Na+ Cl- K+ Ca2+ Glucose Lactate
(mEq/L) (mEq/L) (mEq/L) (mEq/L) (g/L) (mEq/L)
5% Hypo 50
Dextrose (253)
in water
(D5W)
Normal Iso (308) 154 154
Saline
D5 ¼ NS Iso (330) 38,5 38,5 50

D5 ½ NS Hyper 77 77 50
(407)
D5 NS Hyper 154 154 50
(561)
RL Isi 273) 130 109 4 3 28

D5 RL Hyper 130 109 4 3 50 28

(525)
 CRYSTALLOID VS COLLOID
Crystalloid Colloid
Advantages - Inexpensive -More sustained intravascular
- Promotes urinary -Volume increase (1/3 still intravascular at 24 hrs)
flow - Maintain or increase plasma oncotic pressure
- Fluid of choice for -Requires smaller volume for equal effects
initial resuscitation -Less peripheral oedem (more fluids remains
of intravascular)
trauma/hemorrhage
-May lower intracranial pressure
- Expands
intravascular volume
- Restores 3rd spaces
losses
Disadvantages - Dilutes colloid -Expensive
osmotic pressure -May produce coagulopathy (dextrans and
- Promotes peripheral hetastarch)
oedem -With capillary leaks may potentiate fluid loss to
- Higher incidence of the interstitium
pulmpnary oedem -Impairs subsequent crossmatching of blood
- Requires large (dextran)
volume -Dilutes clotting factors and platelet
- Effects are transient -Decrease platelet adhesiveness (absorption onto
platelet membrane reseptor)
-Potential blocking of renal tubules and
reticuloendothelial cells in the liver
-Possible anaphylactoid reaction with dextran
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 Halflife Indication
Weight intravascul
(103) er

Plasma Human plasma Serum 50 4-15 days -Volume substitute

protein human - Hypoprotein
albumin emia
- Hemodilution
Dextran Leuconostoc D 40, 70 60-70 6 hrs -Hemodilution
mesenteroid B 512 -Microcirculation
disturbance

Gelatine Hydrolisis animal - Modified 35 2-3 hrs -Volume substitute

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