CPM 483 Use of micronutrients and intravenous fliuds use in hospital pharmacy.pptx

CPM 483 Use of micronutrients and intravenous fliuds use in hospital pharmacy.pptx

1. ESSENTIAL OF NUTRITION:USE OF MICRONUTRIENTS AND INTRAVENOUS FLUIDS USE IN HOSPITAL PHARMACY CARE ANENE-OKEKE CHIGOZIE GLORIA , Pharm. D, Ph.D , FPCPharm (Cardio, Endo, Renal) (CPM 483) Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical science University of Nigeria Nsukka 2023

2. Outline Definition of Micronutrients Classification of micronutrients Uses of micronutrients Definition IV fluids Uses of IV fluids Classification of IV fluids

3. MICRONUTRIENTS

4. MICRONUTRIENTS Micronutrients are nutrients that the body needs in a smaller amount for development and growth. They are very important to the body's metabolic processes. These include vitamins  and minerals . Vitamins and minerals must be obtained externally from a variety of dietary sources because our bodies cannot create them . It is advisable to eat a variety of foods to get the recommended amount of vitamins and minerals because each food has a unique micronutrient content.

5. These micronutrients aid in the prevention  and treatment of several illnesses. However, they must be consumed in a sufficient amount. Excess or insufficient consumption can cause certain diseases, including vision impairment, mental retardation, and other issues. Types of micronutrients Water-soluble vitamins, fat-soluble vitamins, macro - minerals, and trace minerals are four type of micronutrients. They are all similarly absorbed by the body and interact with various physiological processes.

6. Water- soluble vitamins Two of the main water-soluble vitamins are vitamin C (ascorbic acids) and vitamin B complex : t hiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine ( B6 ), biotin (B7), folic acids  (B9), and cyanocobalamin ( B12 ) .  These vitamins all dissolve in water. You need to eat more of them each day because your body cannot store them for later use. The body excretes any water-soluble vitamins that are not immediately used by the body. They aid your body in gaining energy. They promote the health of your cells, especially the red blood cells.

7. Vitamins Functions Thiamin (B1) Carbohydrate and protein metabolism DNA and RNA production Nerve function Riboflavin (B2) Energy metabolism Niacin (B3) Energy metabolism Vasodilator (can alleviate heat, stress) Pantothenic acid (B5) Involved inn the metabolism of fats and carbohydrate Pyridoxine (B6) Metabolism of amino acids and lipids Synthesis of hemoglobin Biotin (B7) Hoof health (keratin production) Carbohydrate, protein and fat metabolism Folic acid (B9) Nucleic and amino acid metabolism Cyanocobalamin (B12) Coenzyme in methionine production Propionate metabolism DNA production Red blood cell development Vitamin C Powerful antioxidant and is crucial for keeping a healthy immune system , Required for the development of neurotransmitters and collagen

8. Fat-soluble vitamins:  Do not dissolve in water They are stored in the liver  and fatty tissues. F at-soluble vitamins include vitamins A ( Required for vision, immunity, and healthy skin ) , D (bone and teeth formation, muscle contraction, healthy immunity, serve as hormones) , E ( An antioxidant and assists in preventing cell damage ) , and K ( Required for blood clotting and calcium transportation into the bone ) .

9. Macro - mineral  These are needed in higher concentrations than trace minerals. Significant macro - minerals and their roles include: Calcium:  Essential for healthy growth , muscle contraction and formation of the bones Phosphorus:  A component of cell membranes Magnesium:  Needed for the functioning of many enzymes in the body , :  Controls how muscles contract and how signals are sent to the nervous system. Over 300 metabolic processes require it, and it aids in the formation of teeth and bones. Sodium:  Blood pressure regulation and fluid balance Chloride:  Maintains fluid balance and the production of digestive juices Potassium:  Transmission of nerve impulses and muscle action (contraction), maintaining fluid and electrolyte balance Sul ph ur :  Needed for the formation of genetic material and several important proteins in the body

10. Trace minerals Trace minerals include iron, manganese, copper, zinc, and selenium. Trace minerals are critical for muscle health, nervous system function, and repairing damage to cells.  Macronutrients are proteins, fats and carbohydrates.

11. INTRAVENOUS FLUIDS USE IN HOSPITAL PHARMACY CARE

12. Definition A lso known as intravenous solutions or intravenous therapy It constitute the administration of liquid substances directly into the vein and the general circulation. Supplemental fluids used in intravenous therapy to restore or maintain normal fluid volume and electrolyte balance when the oral route is impossible. IV fluid therapy is an efficient and effective way of supplying fluids directly into the intravascular fluid compartment, replacing electrolyte losses, and administering medications and blood products.

13. Reason for infusion 1. Replace fluids and imbalances 2. Maintain fluid, electrolyte and acids-base balance 3. Administer blood and blood products 4. Administer medication 5. Provide parenteral nutrition 6. Monitor cardiac function 7. Immediate result 8. To provide avenue for diagnostic testing 9. Predictable therapeutic effects

14. Classification of Intravenous fluids Intravenous fluids can be classified based on: 1. Tonicity 2.  purpose 3. Molecular weight (MW)

15. Classification based on Tonicity Isotonic solutions: have the same solute concentration as blood plasma eg . 0.9% normal saline Hypotonic solutions: have a lesser concentration of solutes than plasma e.g Hypertonic solutions have a greater concentration of solutes than plasma eg - 10% dextrose in water

16. Classification based on purpose Nutrient solutions- It may contains dextrose glucose, and laevulose to make up the carbohydrate component and water. Water is supplied for fluid requirements and carbohydrates for calories and energy. Nutrient solutions help prevent dehydration and ketosis. Examples of nutrient solutions include 5% dextrose water and 5% dextrose saline Electrolyte solutions- Contains varying amounts of cations and anions used to replace fluid and electrolytes for people with continuing losses. Examples include 0.9% normal saline, Ringer’s Solution, and Lactated Ringer solution. Alkalinizing solutions- They are administered to treat metabolic acidosis Examples: Lactated Ringer solution Acidifying solutions- They are used to counteract metabolic alkalosis example 0.9% normal saline Volume expanders.-used to increase the blood volume after a severe blood loss or loss of plasma Examples are dextran, human albumin, and plasma.

17. Classification based on molecular weight Crystalloids Contain tiny molecules Clear solution Across semipermeable membranes They are categorized according to their relative tonicity in plasma which are isotonic, hypotonic, and hypertonic. Colloids Contain large molecules Do not pass through semipermeable membranes Contain solutes of high molecular weight; technically, they are hypertonic solutions, which, when infused, exert an osmotic pull of fluids from interstitial and extracellular spaces. They help expand the intravascular volume and raise blood pressure. Indicated for patients in malnourished states and patients who cannot tolerate large fluid infusions.

18. Isotonic solutions/ fluids 1. Normal saline solution (0.9% Nacl ) Osmolarity 308 mOsm /L Uses: Content Shock Water Resuscitation Sodium (154mEq/L) Fluid challenges Chloride (154mEq/L) Blood transfusion Metabolic alkalosis Hyponatremia such as burn injuries and trauma Diabetic keto -acidosis (DKA) Caution: in patients with Heart failure (HF) Pulmonary e dema hypernatremia Renal impairment

19. 2. 5% Dextrose in water Osmolarity Uses: 252mOsm/ L Fluid loss and dehydration content Hypernatremia Water Expands the ECF and ICF, aid in rehydrating and excretory purposes Glucose Initially isotonic but when dextrose is metabolized it becomes hypotonic Caution Not used in fluid resuscitation (hyperglycemia can occur) Renal and cardiac impairment Not used in patients at risk of increased intracranial pressure 3. Lactated Ringer’s solution/ Hartman solution Osmolarity Uses: 273 mOsm/ L Dehydration Content Burns, fistula drainage and trauma Water GI tract fluid loss Sodium (130 mEq /L) Acute blood loss Potassium (4 mEq /L) hypovolemia Calcium (3 mEq /L) Metabolic acidosis

20. Chloride (109mEq/L) Caution Lactate (28mEq/L) Patients with H eart failure and renal failure CI: Patients with liver disease, lactic acidosis (cannot metabolize lactate, liver convert lactate to bicarbonate) 4. Ringer’s solution Osmolarity Uses 273mOsm/L Similar to Lactated ringer’s solution Content Water Sodium (130 mEq /L) Caution Potassium (4 mEq /L) Heart disease Calcium (3 mEq /L) Renal impairment Chloride (109mEq/L) High blood pressure

21. Hypotonic solutions/ fluids 1. 0.45 % Normal saline /0.45% NaCl / Half-strength normal saline Osmolarity Uses 154mOsm/L For replacing water in patients who have Hypovolemia hypernatremia Content Caution Water Excessive use may lead to hyponatremia due to the dilution of sodium Sodium (77 mEq /L ) Chloride (77 mEq/L ) 2. 0.33% Sodium Chloride solution (0.33% NaCl )/ 1/3 strength normal saline/ 5% Dextrose in 0.33 Sodium Chloride Osmolarity Uses 365 mOsm /L Used to allow the kidney to retain needed amount of water. Free water helps kidney eliminate solute Content Administered with dextrose to increase tonicity Water Caution Sodium (56mEq/L) In patients with heart failure and renal insufficiency Chloride (56mEq/L) Glucose (50g/L) 170 Kcal/L

22. Hypotonic solutions/ fluids 3. 0.225% Sodium Chloride Solution/ 5% Dextrose in 0.225 Sodium Chloride Osmolality Uses 77mOsm /L used as a maintenance fluid for pediatric patients as it is the most hypotonic IV fluid available. Content Administered with dextrose to increase tonicity Water Sodium (38mEq/L) Chloride(38mEq/L) Glucose (50g/L) 4. 2.5 % Dextrose in water (2.5% DW) Osmolality Uses 126mOsm /L To treat dehydration Content Treat decreased level of Sodium and potassium Water Caution Glucose (25g/L ) Not to be administered with blood products because of hemolysis of the red blood cell

23. Hypertonic solutions/ fluids 1. Hypertonic sodium chloride solution 3% NaCl Uses: Sodium (513mEq/l) Severe hyponatremia Chloride (513mEq/l) Cerebral edema Osmolality Some patients mat need diuretic therapy to assist in fluid excretion 1030 mOms /L 5% NaCl Caution: Sodium (855 mEq /l) It should be infused at a very low rate to avoid risk of pulmonary edema Chloride (855 mEq /l) If administered in large quantities and rapidly, they may cause excess fluid in the ECF and circulatory Osmolality 1710 mOms /L 2. Dextrose 10%/ Dextrose 10% in water Osmolality Uses : 505 mOms /L Insulin induced Hypoglycemia Shock

24. Dehydration Nutritional support Caution 3. 20% dextrose in water Osmolality Uses 660 mOms /L An osmotic diuretic that causes fluid shifts between various compartments to promote diuresis. Content Extreme dehydration cases due to limited water intake, diarrhea, vomiting or excessive urinating Water Treatment of insulin hypoglycemia Glucose (200g/L) Caution Intracranial hemorrhage severely dehydrated. anuria Coma relating to liver disease

25. 4. 50% dextrose in water Osmolality 2523 mOms /L Uses Content Treat severe hypoglycemia Water Caution Glucose (500g/L) intracranial or intraspinal hemorrhage 5. Mannitol 10%, 20% Osmolality Uses 1372 mOms /L reduction of intracranial pressure and brain mass Content reduce intraocular pressure Mannitol Promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage water Contraindication Pulmonary edema Severe dehydration

26. 6. Osmolality (Full strength) Full strength and half strength Darrow’s solution 312 mOms /L uses Content Hypertension Potassium chloride Blood and fluid loss Sodium chloride Arrhythmias Sodium lactate Potassium deficiency Electrolyte imbalance Low sodium, magnesium, calcium Contraindication Congestive heart failure Hepatic insufficiency Liver cirrhosis Concomitant digitalis therapy 7. 4.3% dextrose saline Osmolality Read up 560 mOms /L

27. Colloids Colloid solutions contain large molecules that do not pass through semipermeable membranes and therefore remain in the blood vessels. Also known as volume/plasma expanders They contain solutes of high molecular weight; technically, they are hypertonic solutions, which, when infused, exert an osmotic pull of fluids from interstitial and extracellular spaces. They help expand the intravascular volume and raise blood pressure. Colloids indicated for patients in malnourished states and patients who cannot tolerate large fluid infusions.

28. 1. Albumin Osmolarity Albumin (5%) 309 mOsm /L used to increase the circulating volume and restore protein levels in conditions such as burns, pancreatitis, and plasma loss through trauma Albumin (25%) 312 mOsm /L Angiotensin-converting enzyme (ACE) inhibitors should be withheld at least 24 hours before administration due to risk of atypical reaction (flushing and hypotension) Hypalbuminemia Contraindication in severe anemia, heart failure or known sensitivity to albumin. 2. Dextran They are available in either saline or glucose solutions. Low-molecular weight dextran (LMWD); with an average molecular weight of 40,000 (Dextran 40) Contains polysaccharide molecules that behave like colloids They contain no electrolytes Used for volume expansion LMWD used to improve microcirculation in patients with poor peripheral circulation Fluid resuscitation

29. use it to treat shock related to vascular volume loss (e.g., burns, bleeding, trauma, or surgery) For specific surgical procedures, LMWDs used to prevent venous thromboembolism Dextran interferes with blood crossmatching, so draw the patient’s blood before administering dextran if crossmatching anticipated. Contraindication Thrombocytopenia hyperfibrinogenemia Avoid with hemorrhagic shock. 2b . Dextran 70 or 75 High-molecular-weight Dextrans (HMWD) HMWD contains polysaccharide molecules with an average molecular weight of 70,000 (Dextran 70) or 75,000 (Dextran 75) HMWD used for patients with hypovolemia and hypotension Contraindicated Patients with hemorrhagic shock.

30. 3. Gelatin Gelatins have a lower molecular weight than dextrans and remain in circulation for a shorter period. 4. Etherified Starch These solutions derived from starch and used to increase intravascular fluid but can interfere with normal coagulation. Plasma Protein Fraction (PPF) Plasma Protein Fraction is a solution that also prepared from plasma. Finally, like albumin, heated before infusion.  So, recommended infusing slowly to increase circulating volume.