7 types of IV fluids for the intravenous use RL, DNS, NS, D5 , D10

7 types of IV fluids and thier usage and indications

1. Dextrose & Saline Solution
Offers

2. Introduction
Water is a fundamental component of cells
Total body water = 60% of the body weight
Variations occur
-- Age
80% neonate is water
-- Gender
-- Amount of body fat
Body fluid includes

Water

Electrolytes

3. Function of fluids
Water is used for

Circulation of blood

Respiration

Elimination of waste

Basis of blood, enzymes, hormones,
perspiration, mucus, saliva and digestive juices

Lubricates the joints, moisturizes the skin,
muscles and internal organs

Regulation of body temperature

4. Body Fluid Physiology

5. Body Fluid Physiology Chart
Total Body Fluid (60%)
Intracellular Fluid (40%)Extra cellular Fluid (20%)
Interstitial Fluid (16%) Intravascular Fluid
(4%)
K
+
, PO
4
3-
, SO
4
2-
Na
+
, Cl
-
, HCO
3-

6. Body Fluid Physiology
Input ml Output ml
Fluids 1500 mlUrine 1500 ml
Semi solid & solid700 mlSkin 500 ml
Water of oxidation300 mlLungs 400 ml
Stools 100 ml
Total 2500 mlTotal 2500 ml
Total fluid Input = Total Fluid Output

7. Factors that Affect Fluid Volume
Age

Adults’ body water ~ 60% of total BW

Infants’ body water as high as 80% of BW
Gender

Male has greater amount of water per body weight
Weight

Fat contains less water
i.e. Obese person has less percentage of water

8. Additional Water Requirement
Clinical Situation Water Req’t
Temperature elevated by 1
o
C 0.1-0.3 L
Moderate sweating 0.5 L
Mild sweating with high fever 1.0 – 1.5 L
Hyperventilation 0.5 L
Hyperventilation in very dry surroundings1.0 – 1.5 L
Operation lasting for 5 hours 0.5 – 3.0 L

9. Control Mechanism

Anti-diuretic hormone


Aldosterone

Glucocorticoids

Natriuretic hormones

10. Electrolytes

11. Electrolytes
Charged ion in a fluid
Act as conductors of electric current
Such ionizing substances are called electrolytes

Eg. Na
+
, Cl
-
, Mg
2+
, K
+
, HCO
3-
Types of electrolyte
Cations
Positively charged electrolytes
Eg. Na
+
, K
+
, Mg
2+
, Zn
2+
Anions

Negatively charged electrolytes

Eg. Cl
-
, PO
4
3-
, SO
4
2-
, HCO
3-

12. Electrolytes of ICF
Cations mEq/L Anions mEq/L
Potassium 150 Phosphate &
sulphates
150
Magnesium 40 Proteins 40
Sodium 10 Bicarbonate 10

13. Electrolytes of ECF
Cations mEq/L Anions mEq/L
Sodium 144 Chloride 114
Potassium 4 Bicarbonate 30
Calcium 3 Phosphate 3
Magnesium 2 Sulphate 6

14. Dehydration

15. Dehydration

Excessive loss of water from the body
DEHYDRATION = WATER LOSS + SODIUM LOSS

16. Types of Dehydration
Types Loss of Body Fluid
Mild Dehydration Upto 5% of body fluid
Moderate DehydrationUpto 10% of body fluid
Severe Dehydration Upto 15% of body fluid

17. Causes of Dehydration
Vomiting and Diarrhoea 
Excessive Sweating
High fever 
Burns
Pre and post operative patients
Renal or Hepatic diseases
Congestive cardiac failure
 Severe injury

18. Causes, Symptoms and Treatment of Water Deficit
Causes Symptoms Treatment
Deficit Intake
Inadequate water supply
available
Failure of thirst to stimulate
intake Eg. Coma, hypothalamic
lesions
Excessive Output
Surface

Increase evaporation
Kidney

Failure to concentrate urine
Eg. Diabetes insipidus

Osmotic diuresis

Other renal losses without full
water replacement, e.g. polyuria
after urinary tract obstruction
Intestine

Severe diarrhoea
Reduction in amount of urine
execration (Oliguria) or no
urine (Anuria)
 
Acute weight loss, more than
5% of body weight
 
Dryness of skin and mucous
membrane
 
Longitudinal wrinkling of
tongue
 
Hypotension
 
Tachycardia
 
Lowered body temperature
Treatment of primary
disorder
 
0.9% Normal Saline
 
Ringer Lactate
 
5% Dextrose

19. Causes, Symptoms and Treatment of Water Excess
Causes symptoms Treatment
Excessive Intake

Therapeutic error

Excessive drinking

Repeated hypotonic enemas

Water absorption during
resection of the prostate
Reduced output
Concentrated urine

Inappropriate ADH release

ADH secretion by tumour

Drugs with ADH like activity
or
stimulating ADH release

Other conditions: adrenal
glucocoricoid deficiency,
hypothyroidism
Renal failure
Water Intoxication

Confusion

Fixed stare

Inability to talk

Nausea & vomiting

Delirium

Muscular weakness

Drowsiness

Coma
Isotonic volume excess

Acute weight gain, in excess
of
5% of body weight

Oedema

Shortness of breath
(dyspnea)

Bounding pulse, as a result
of
increase in plasma volume
Treatment of primary disorder
 
Fluid restriction, possibly
dialysis.
Osmotic diuretic (Mannitol
20%)
 

20. Isotonic Dehydration

Most Common form of Dehydration

Occurs when fluids and electrolytes are lost in even
amounts

There are no intercellular fluid shifts
Common Causes
Diuretic therapy
Excessive vomiting
Excessive urine loss
Hemorrhage
Decreased fluid intake

21. Hypertonic Dehydration
•Second most common type of dehydration
•Occurs when water loss from ECF is greater
than solute loss
•Pure water loss with high fevers, and watery
diarrhea.
•Diabetic Ketoacidosis and Diabetes Insipidus

22. Hypotonic Dehydration
Relatively Uncommon - Loss of more solute
(usually sodium) than water.
Hypotonic Dehydration causes fluid to shift
from the blood stream into the cells,
leading to decreased vascular volume and
eventual shock

Increased cellular swelling

23. Energy

24. What is Energy?
The capacity to do physical and metabolic activity
Energy requirement
Condition Recommendation For 60kg
person
No stress 28 Kcal/kg/day 1680 kcal/day
Mild stress 30 Kcal/kg/day 1800 kcal/day
Moderate stress 35 Kcal/kg/day 2100 kcal/day
Severe stress 40 Kcal/kg/day 2400 kcal/day

25. Energy Source
Carbohydrate
Protein
Fats

26. Carbohydrate
Major source of energy
Provide instant energy in critical/emergency cases
Contributing to 45% of total energy uptake
Control of blood sugar and insulin metabolism
Instant source of energy
400-600 calories store in body in the form of
carbohydrate

27. Energy Management
Treatment options

Dextrose and saline solution

Invert sugar solution

Other protein and fat preparation

28. Use of intravenous fluids

Three Major Uses:

In imbalance or depletion of body fluids

To establish and maintain life support in
casualty

To provide an access for medication
administration

To provide daily maintenance needs of fluid
and electrolytes

29. AXA offers
Dextrose and Saline Solutions
• 5D, 10D, 25D
• NS
• DNS

30. 5D (5% Dextrose Solution)
Composition
Each 100 ml contains
Dextrose IP 5 gm
Water For Injection IP q.s.

31. Pharmacodynamic

Dextrose converted to energy

Crab’s cycle chart

32. Pharmacokinetics

Provides Energy

Vehicle for numerous drugs

Increase movements of electrolytes across
semipermeable membrane

Metabolized into glycogen

Corrects the fluid imbalance or water loss

33. Indications
Prevention of

Dehydration

Depletion of liver glycogen

Excessive tissue protein catabolism

Diarrhoea

Vomiting

High Fever

34. Contd...

Oral intake limited

Correction of deficits of water

Sodium Excretion due to excess in body

35. Contraindication

Overhydration

Not given conjointly with blood

In liver’s disease

Neurosurgical Procedures

36. Dosage

1500-3000 ml/day for short term maintenance
Therapy

1500-2000 ml/day over 8-12 hr (to prevent tissue
catabolism)

37. 10D (10% Dextrose Solution)
Composition
Each 100ml contains:
Dextrose I.P. 10 gm
Water for injection I.P. Q.S

38. Indications

Energy to body

Vehicle for numerous drugs

Water to correct ECF volume

Initiate osmotic diuresis

39. Contd...

An osmotic diuretic

Higher amount of calories

Fluid and Nutrient replenisher

Temporary relief from Hypoglycemic coma

40. Contraindication

Not given conjointly with blood

Overhydration

In diabetic patients

41. Dosage

100 to 1000ml/day for infants

200 to 2000ml/day for children

1000 to 3000 ml for adults

42. 25D (25% Dextrose Solution)
Composition
Each 100ml contains:
Dextrose IP 25 gm
Water for injection IP q.s.

43. Indication

Severe energy requirement of the body

Used in jaundice

Sclerosing agent for treatment of Varicose of
veins

Veterinary practice

44. Contraindication

Not given conjointly with blood

In liver’s disease

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46. NS - (Normal Saline)
Composition
Each 100ml contains:
Sodium Chloride IP 0.9gm
Water For Injection q.s.

47. Pharmacodynamic

Used in hypotonic dehydration

Sodium deficit

48. Indication

Electrolyte Replenisher

Hydrating Fluid In Dehydration

Used along with Blood

Establishment Of Renal Function

Primary Solution In Haemodialysis

Preservation Of Skin Grafting

Severe Salt Depletion

49. Contraindication

Inadequate Replacing Electrolyte Deficits
Involving ICF

50. Dosage
1 litre / day in average adult

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52. DNS - (5% Dextrose with NS)
Composition
Each 100ml contains
Dextrose Anhydrous I.P. 5gm
Sodium Chloride I.P. 0.9gm
Water for injection Q.S.

53. Pharmacodynamic

Energy & correct Electrolyte Imbalance

Supplies water along with essential salts.

54. Indication

Nutrient in fluid that doesn’t hydrate the tissues

Calories needed (Cl loss >= Na Loss)

Use with blood who need additional fluid with
minimal Na intake

55. Contraindication

Renal Insufficiency

Oedema

Cardiac

Hepatic

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57. Ringer Lactate (RL)

Balanced salt solution

Physiological solution

Hartmen solution

58. Composition
Each 100 ml contains
Sodium Chloride IP 0.6g
Sodium Lactate IP 0.3g
Potassium chloride IP 0.04g
Calcium chloride IP 0.027g
WFI IP q.s.

59. Electrolytes Comparison
Sr.noElectrolytes mEq/lPlasma RL NS
1 Na 140 130154
2 Cl 102 109154
3 Bicarbonate 28 28 0
4 K 4 40
5 Ca 5 3 0
6 pH 7.4 6.56.1

60. Pharmacodynamic

Sodium Lactate metabolized in liver to
bicarbonate

Used as bicarbonate precursor

Treating mild case of metabolic acidosis

61. Indication

Replace deficit of ECF

Burns, Trauma, Dehydration

Restoration of normal ECF balance during surgery

Renal insufficiency, diarrhoea

62. Role of RL in Burns

Composition similar to plasma which is lost in
burns

Lactate converted to Bicarb., taking care of
metabolic acidosis in burns

supplies Pot. essential for intracellular electrolyte
replenishment

Na & Cl conc. similar to plasma

63. RL in Skin Graft Therapy

Storage solution : Rich in potassium

Keep tissues alive

Healthy for regeneration

64. RL in Dehydration

Deficit control

Corrects acidosis

Proper electrolytes fulfillment

65. RL superior to other Sols.

NS: contains Na & Cl
-
in excess. No K
+

DNS: Na
+
& Cl
-
in excess

5D: No electrolytes

Improlyte: contains no Calcium

66. Contraindication

In liver disease

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68. Thank You