Types of fluids:
Crystalloids and
colloids.
Crystalloids are aqueous solutions of mineral
salts or other water-soluble molecules.
Colloids
contain larger insoluble molecules, such as gelatin; blood.
Osmolarity and Tonicity
·
The
Osmolarity of a fluid is determined by the number of dissolved particles, or
solutes, in 1L of water.
·
The
Tonicity is the Osmolarity of a solution with respect to plasma.
Isotonic crystalloids
·
Can
expand the circulating intravascular fluid volume without causing major fluid
shifts between compartments.
·
Isotonic
crystalloids are often used to treat fluid loss due to vomiting, diarrhea or
surgical procedures especially when blood pressure is low.
·
Because
isotonic fluids can rapidly expand, circulating blood volume care must be taken
not to create fluid overload.
Isotonic fluids
·
0.9%
sodium chloride solution, Lactated Ringer's solution, Blood components, Albumin
5%, Plasma
·
Dextrose
5 % in water (D5W) (in the bag) (this is
physiologically hypotonic as dextrose get metabolized quickly only water
remains so inside the body it is hypotonic)
Hypotonic
crystalloids
Will
cause water to move out of the plasma to the tissues and cells in the
intracellular compartments; thus, these solutions are not considered efficient
plasma volume expanders.
Hypotonic
crystalloids are indicated for clients with hypernatremia and dehydration.
Care
must be taken not to cause depletion of the intravascular compartment or too
much expansion of the intracellular compartment.
Hypotonic solutions
·
Administration
of this fluid generally causes dilution of plasma solute concentration and
forces water movement into cells to reestablish intracellular and extracellular
equilibrium; cells will then expand or swell.
·
0.45%
sodium chloride solution (half-normal saline)
·
0.33%
sodium chloride solution (one-third normal saline)
Hypertonic
crystalloids
·
Infusion
of hypertonic crystalloids expands plasma volume by drawing water from the
cells and tissues.
·
These
agents may be used to relieve cellular edema, especially cerebral edema.
·
Over
treatment with hypertonic crystalloids can lead to excessive expansion of the
intravascular compartment and hypertension.
Hypertonic solutions
·
Dextrose
Normal Saline,
·
D5W
in half-normal saline,
·
Dextrose
10% in water,
·
3%
or 5% sodium chloride solution.
Colloid Solutions
·
Hydroxyethyl
starch
·
Dextran
40 in NS or 5% D5W
Monitoring for
complications of fluid restoration:
·
Use
of monitors to measure fluid volume- CVP
·
Urine
output, body weight
·
Serum
sodium, potassium, BUN, osmolality monitoring.
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