IV FLUIDS
IV Fluids – Introduction
• Chemically prepared solution– Solvent= water– Solutes= material (sodium, potassium, chloride; and
other larger compounds like proteins/molecules)
• Tailored to the body’s needs• To replace lost fluids and/or aid in the delivery of
IV medications• Have different forms & different impacts on the
body
Phase of fluid therapy
• Emergency phase– Returning the patient's status to normal (deficit
volume)• Replacement phase– Replacing normal ongoing losses (maintenance
volume)• Maintenance phase– Replacing continuing abnormal losses (continuing
losses volume)
TBW = Total Body Water
Trancellular fluids: CSF, pleural fluid, peritoneal fluid, intra ocular fluid, synovial fluid Plasma is intravascular fluidInterstitial fluids: tissue
fluids and lymph fluid
Normal body fluid loss
• Urine (50%)– Normal: 50 ml/ kgBB/ 24 jam
• Insensible Water Loss (50%)– Respiration (15%)– Skin (30%)– Feces (5%)
The Fluid’s Tonicity
• HypertonicTonicity > plasma
• IsotonicTonicity = plasma
• HypotonicTonicity < plasma
Tonicity: concentration of electrolytes dissolved in the water, compare with body plasma
The Fluid Tonicity Comparison
IV Fluids different forms
• Colloids• Crystalloids• Blood and blood products
Colloid versus Crystalloid
Colloid solutions• Large proteins/molecules• Remain in the blood vessels• Attract water from cells into
blood risk of dehydration• Used for maintaining blood
volume• Expensive• Common solutions:
– Plasma protein fraction– Dextran– Hetastarch
Crystalloid solutions• Contain electrolytes, but lack
of large proteins /molecules• Have tonicity as patient’s
need• In 1 hr 2/3 will leave blood
vessels risk of fluid effusion • Used mainly for pre-hospital
setting & maintanance• More available and afordable• Common solutions:
– Lactated Ringer’s– Normal saline solution (NaCl)– D5
Label of IV fluid container
• Type of IV fluid (name & type of solutes contained within)
• Amount of IV fluid (mL)• Expiration dates
RINGER LACTAT, RINGER ASERING, HARTMANN’S SOLUTIONComposition RL
(Ringer Lactate)
Asering® (Ringer Acetate)
Hartmann’s solution (compound sodium lactate)
Na+ 130 130 131
Cl- 109 108.7 111
K+ 4 4 5
Ca++ 3 2.7 4
Acetate 28 28 29
Information Good for liver problems because acetate is metabolized in muscle
Contra-indicated to diabetes patients because of isomers of lactate is glucogeogenic
KAEN ® KAEN 1B KAEN 3A KAEN 3B KAEN 4A KAEN 4B
CompositionSodium (Na++)Potassium (K+)Chloride (Cl-)DextroseLactate
38.5
38.537.5 gr/L
60105027 gr/L20
5020502720
30-204010
3082837.510
Fluid requirements for adult
• Daily maintenance fluid requirements vary between individuals.– 70 Kg male = 2500 – 3000 ml/day water, 120 –
140 mmol sodium and 70 mmol potassium– 40 Kg woman = 2000 ml/day, 70 – 90 mmol
sodium and 40 mmol potassium
Fluid requirements• By BSA (Body Surface Area) = mL/ m2/ 24 hr– Appropriate for BW > 10 kg– Normal for maintenance fluid is 1500 ml/ m2/ 24 hr
• By body weight (Global formula):– 100 ml/ kg – first 10 kg– 50 ml/ kg – second 10 kg– 20 ml/ kg – BW > 20 kgEx: a child with BW 25 kg, needs
100 ml/ kg x 10 kg = 1000 cc – 10 kg (I) 50 ml/ kg x 10 kg = 500 cc – 10 kg (II)20 ml/ kg x 5 kg = 100 cc – 5 kg (cont.)
Total = 25 kg = 1600 cc/ 24 hr
Fluid requirements for children
• By Darrow – <3kg : 175cc/kg/day– 3-10kg : 105 cc/kg/day– 10-15kg : 85cc/kg/day– >15kg : 65 cc/k/day
• By Holiday and Segard– 10 kg (I) : 4 cc/kg/hr– 10kg (II) : 2cc/kg/hr– 10 kg (III) : 1 cc/kg/hr
Things will change fluid requirements• Increase metabolism:– Fever will ↑ H2O: 12%/ °C
• Decrease metabolism:– Hypotherm will ↓ H2O 12%/ °C
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