Basics in clinical

pharmacy
Dr/ Alaa Al Sayed
SOAP Analysis
SOAP Note
structure
Clinical assessment of
ICU Patients
FLUIDS
 Crystalloids packed red blood cells,
pooled human plasma (5% albumin, 25%
albumin, and 5% plasma protein fraction),
semisynthetic glucose polymers (dextran), and
semisynthetic hydroxyethyl starch (hetastarch).
Types of Fluids

Colloids(0.9% sodium chloride ,

lactated Ringer solution or D5W )
  Resuscitation :
 Intravascular fluid depletion correlates with
reduce cardiac function and organs
hypoperfusion
GOAL Of  Maintenance :
 In patients who are unable to tolerate oral
Fluids fluids to prevent dehydration and maintain
normal fluids and electrolyte balance
 a. Intravenous fluids are infused rapidly, preferably through a large-
bore catheter.
b. Intravenous fluids are administered as a 500- to 1000-mL bolus,
Resuscitation after which the patient is reevaluated;
this process is continued as long as signs and symptoms of
intravascular volume depletion
are improving
  When to think of colloids ?
 Colloids can be considered after fluid resuscitation with crystalloid
(usually 4–6 L) has failed to achieve hemodynamic goals or after
clinically significant edema limits the further administration of
crystalloid.
 Albumin can be considered in patients with a low albumin
Resuscitation concentration who have required a large volume of resuscitation
fluids.
 Albumin (theoretically, 25% is preferred) can be considered in
conjunction with diuretics for patients with clinically significant
edema (e.g., pulmonary edema causing respiratory failure) and a
low albumin concentration, when appropriately dosed diuretics
are ineffective.
  Common methods of estimating the daily volume in children and
adults:
 a. Administer 100 mL/kg for first 10 kg, followed by 50 mL/kg for
the next 10–20 kg (i.e., 1500 mL for the first 20 kg) plus 20 mL/kg
Maintenance for every kilogram greater than 20 kg or
 b. Administer 20–40 mL/kg/day (for adults only).
 c. Adjust fluids according to the individual patient’s input, output, and
estimated insensible loss.
THANK YOU
Apps