Fluid and Electrolytes Theraphy

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    Crystalloids

    Ex: isotonic, hypotonic, hypertonic

    Colloids

    > Increase intravascular colloid osmotic

    pressure.

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    Hypotonic fluid

    Isotonic fluid

    osmolality: 240-340 mOsm/L

    Ringers lactate, blood component

    Hypertonic fluids

    > osmolality: 340 mOsm/L

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    Not true solutions

    Blood products

    Stabilized human serum

    Human albumin

    Plasma protein factor

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    Resucitation fluid

    Maintenance fluid

    Replacement fluid

    Total parental nutrition

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    Resucitation fluid

    Hypoxia, septicemia

    Stabilized human serum

    Fresh frozen plasma

    Ringers lactate

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    Maintenance fluid

    Supplies H2O and electrolytes

    Hypotonic solutions

    0.45 % NaCl

    5 % dextrose water

    0.2 % NaCl

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    Replacement fluid

    Correct fluids and electrolytes balance

    Contains 3x more Na than maintenance

    fluids

    2 types:

    Half- strength Darrows Half- normal saline

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    Total parentaral nutrition

    Meet fluids electrolytes and nutritional

    requirements

    Pt with NGT

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    Mild dehydration

    thirsty, alert, restless

    Estimated fluid deficit: 4-5 ml or 40-50 kg

    Pinch retracts immediately

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    Moderate dehydration

    thirsty, restless, lethargic, irritable to touch

    or drowsy, hypotension

    6-9ml, 60-90 kg

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    Severe dehydration:

    Drowsy, cold sweaty, cyanotic

    extremities; maybe comatose

    Concious, apprehensive, wrinkled skin offingers and toes muscle cramps.

    Pinch retracts: very slowly approximately72 secs.

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    Extracellular volume deficit

    Extracellular volume excess

    Na deficit

    Na excess

    K deficit

    K excess

    Ca deficit

    Ca excess

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    Finding Possible cause

    skin

    Poor skin turgor Fluid volume defici

    Cold clammy skin Na deficit

    Pitting edema Fluid volume excess

    Flushed, dry skin Na excess

    Pulse

    Bouncing Fluid volume excess

    Rapid, weak, thready pulse Na deficit

    Weak, irregular, rapid pulse Severe K deficit

    Weak, irregular, slow pulse Severe K excess

    Blood pressure

    Hypotension Fluid volume deficit, Na deficit

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    Hypertension Fluid volume excess,

    Respiration

    Deep, rapid breathing Matabolic acidosis

    Shallow, slow irregular breathing Metabolic alkalosis

    Shortness of breath, Moist crackles

    skeletal muscle

    Fluid volume excess

    Cramping of exercised muscle Ca deficit

    Carpal spasm ( trousseaus sign) Ca deficit

    Flabby muscles K deficit

    Positive Chvosteks sign Ca deficit

    Behavioral of mental

    Picking at bedclothes K and mg deficit

    Indifference Fluid volume deficit, Na deficit

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    Apprehension Shift of plasma to intersitial fluid

    Extreme restlessness K excess, fluid volume deficit

    Confusion K deficit, fluid volume excess