Fluid Therapy and plasma expanders with pharmacology

Fluid Therapy and plasma expanders with pharmacology with various indications

1. Fluid Therapy / Plasma Expander

2. Fluid therapy
 Mainstay of treatment in shock
Increases the plasma volume and ventricular
preload to the extent that it impacts positively
on CO
Crystalloids and colloids

3. Crystalloids – 0.9% saline, Ringer lactate
Advantages Disadvantages
Expands ECF effectivelyMay cause pulmonary edema
Better preservation of cardiac,
renal functions
Absence of anaphylactic
reactions
Absence of coagulation
abnormalities
Cheaper

4. Colloids (Plasma expanders)- Human albumin,
HES, Dextrans
Advantages Disadvantages
Less volume and time Costly
Effective and long duration of
restoration of blood volume
May bind and decrease ionized
fraction of sr. calcium
Improves O2 transport Decrease circulating immunoglobulin
levels
Decrease capillary permeabilityDecrease endogenous albumin
production

5. Plasma expanders
•High molecular wt substances exerts colloidal
osmotic(oncotic) pressure as plasma.
•Correct hypovolemia due to loss of plasma/blood
•Human plasma may carry HIV/HB
•May not available at time
•Expensive

6. Desirable Plasma expanders
•Exerts same colloidal osmotic pressure as plasma
•Remain in circulation and should not leak
•Pharmacodynamically inert
•Stable, nonantigenic, nonpyrogenic
•Should not interfere with blood grouping & crsoss
matching

7. Human albumin
 Nearly an ideal plasma expander
Obtained from pooled human plasma
Free of transmitting diseases like hepatitis
Can be given to any blood group
20% of 100 ml= 400ml FFP/800ml Blood

8. Uses
Burns/hypovolemia, shock
Acute hypoproteinemia
Acute liver failure
Dialysis
Drawbaks
Febrile reactions.
Expensive

9. Dextrans (40 & 70 )
 Polysaccharide obtained from sugar beat
Most commonly used D-70%
It expands volume for 24hrs
Interferes with blood grouping and cross
matching, platelet function & coagulation
Rarely antigenic

10. Dextrans
Shelf life is 10yrs and cheap
Dextran 70 Dextran 40
MW 70,000 MW 40,000
Acts slowly Acts rapidly
--- Decreases blood viscosity hence
improves microcirculation
Not filtered Filtered at glomerulus, short acting
6% solution 10% solution

11. Hydroxyethyl starch (6%)
Mixture of complex amylopectines,
MW- 10,000-1,00,000
Similar to albumin as colloidal property
Action lasts for 24 hrs or more
S/E- Fever, urticaria, itching, bronchospasm

12. Degraded gelatin
 Polypeptide, MW- 30,000
 Similar to HES in all aspects, but more
expensive
Acts for 12 hrs
S/E - Flushing, urticaria, rigors

13. Polyvinylpyrolidone (PVP)
Synthetic polymer, MW- 40,000
Antigenic, interferes with blood grouping and
cross matching
Binds with circulating penicillins and insulin
3% solution in NS, Rarely used now a days.

14. Uses of plasma expanders
IN case of Plasma loss
•Burns
•Hypovolemic shock
•Endotoxic shock
•Severe trauma & extensive tissue damage
•Temporarily in whole blood loss till blood is
available

15. Containdications
•Severe anemia
•Cardiac failure
•Pulmonary oedema/ hypertension
•Renal insufficiency

16. Crystalloids Vs colloids
Which is best ???

17. The SAFE study investigators
“ A comparison of albumin and saline for
resuscitation in intensive care unit, NEJM
2004; 350 ;2247-56”
- Suggests no mortality benefit

18. • Most recent trials also shown that
“ Crystalloids are superior to colloids for fluid
resuscitation. There is no need to fear about
pulmonary edema if monitored carefully”

20. Anaphylactic shock
•Life threatening condition caused by various
agents such as drugs, foods, chemicals etc.
•Respiratory distress, laryngeal edema,
bronchospasm, circulatory collapse, death if
not treated
•IgE mediated, Histamine plays imp. role

22. Angio-oedema

23. Treatment
•Early diagnosis
•Care of Airway, oxygen therapy
•Adrenaline is the DOC
•Dramatic reversal of hypotension,
bronchospasm and laryngeal edema

24. 0.5 ml of 1:1000 solution IM

repeat if necessary after 20 min
5-10 ml of 1:10000 sol. Slow IV
OR instill through ET
NEVER give adrenaline 1:1000 IV
Fluid resuscitation is maintained

25. •Inj. Diphenhydramine 50-100 mg IV/IM for
urticaria-angioedema
•Inj. Aminophylline 250-500 mg IV to relieve
bronchospasm
•Inj. Hydrocortisone 100 mg 6 hrly followed by
Tab. Prednisolone till pt improves
•Inj. DA 5 µg/kg/min increased to 20 µg/kg/min
may be used to elevate BP.

26. Oxygen IV fluids Steroids
Anaphylactic shock
Adrenaline
Urticaria Bronchospasm Hypotension
Angioedema
Diphenhydramine Aminophylline DA