IV fluids and Electrolytes.pptx

It provide more information regarding IV fluids and Electrolytes which is very essential for human body. Also about related complication and its management.

1. IV FLUIDS AND ELECTROLYTES MS. DRASHTI PATEL NURSING TUTOR

2. INTRODUCTION Intravenous fluids, also known as intravenous solutions, are supplemental fluids used in intravenous therapy to restore or maintain normal fluid volume and electrolyte balance when the oral route is not possible.

3. TYPES OF IV FLUIDS based on their tonicity

4. based on their purpose

5. Crystalloids Crystalloid IV solutions contain small molecules that flow easily across semipermeable membranes .

6. Isotonic IV Fluids Same concentration of solutes as blood plasma. Isotonic solutions expand both the intracellular fluid and extracellular fluid spaces, equally. Do not alter the osmolality of the vascular compartment. Isotonic iv fluids have a total osmolality close to that of the ECF and do not cause red blood cells to shrink or swell.

7. 0.9% NaCl (Normal Saline Solution, NSS ) Is a crystalloid isotonic IV fluid that contains water sodium (154 meq /L) chloride (154 meq /L). It has an osmolality of 308 mosm /L and gives no calories .

8. It is called normal saline solution because the percentage of sodium chloride dissolved in the solution is similar to the usual concentration of sodium and chloride in the intravascular space. Normal saline is the isotonic solution of choice for expanding the extracellular fluid volume because it does not enter the intracellular fluid. It is administered to correct extracellular fluid volume deficit because it remains within the ECF.

9. INDICATION - To replace large sodium losses such as in burn injuries and trauma. CONTRAINDICATION - F or heart failure, pulmonary edema , and renal impairment, or conditions that cause sodium retention as it may risk fluid volume overload.

10. Dextrose 5% in Water (D5W) Serum osmolality of 252 mosm /L. D5w is initially an isotonic solution and provides free water when dextrose is metabolized (making it a hypotonic solution), expanding the ECF and the ICF. It is administered to supply water and to correct an increase in serum osmolality. A liter of D5w provides fewer than 200 kcal and contains 50g of glucose.

11. It should not be used for fluid resuscitation because hyper-glycemia can result. It should also be avoided to be used in clients at risk for increased intracranial pressure as it can cause cerebral edema .

12. Lactated Ringer’s 5% Dextrose in Water (D5LRS) Also known as ringer’s lactate or hartmann solution ) Designed to be the near-physiological solution of balanced electrolytes. It contains 130 meq /l of sodium, 4 meq /l of potassium, 3 meq /l of calcium, 109 meq /l of chloride. It also contains bicarbonate precursors to prevent acidosis. It is the most physiologically adaptable fluid because its electrolyte content is most closely related to the composition of the body’s blood serum and plasma

13. USE To correct dehydration Sodium depletion Replace GI tract fluid losses Fluid losses due to burns, fistula drainage, and trauma. It is the choice for first-line fluid resuscitation for certain patients. It is often administered to patients with metabolic acidosis.

14. CONTRAINDICATION Lactated ringer’s solution is metabolized in the liver , which converts the lactate to bicarbonate , it should not be given to patients who cannot metabolize lactate ( E .G., Liver disease, lactic acidosis). It should be used in caution for patients with heart failure and renal failure .

15. Ringer’s Solution R inger’s solution is another isotonic iv solution that has content similar to lactated ringer’s solution but does not contain lactate.

16. Hypotonic IV Fluids Hypotonic IV solutions have a lower osmolality and contain fewer solutes than plasma . They cause fluid shifts from the ECF into the ICF to achieve homeostasis, therefore, causing cells to swell and may even rupture.

17. Iv solutions are considered hypotonic if the total electrolyte content is less than 250 meq /l. U se – To provide free water for excretion of body wastes, T reat cellular dehydration Replace the cellular fluid.

18. 0.45% Sodium Chloride (0.45% NaCl) Also known as half-strength normal saline Used for replacing water in patients who have hypovolemia with hypernatremia. Excess use may lead to hyponatremia due to the dilution of sodium, especially in patients who are prone to water retention. O smolality - 154 mosm /L and contains 77 meq /L sodium and chloride. Use - to treat hypernatremia and other hyperosmolar conditions .

19. 0.33% Sodium Chloride (0.33% NaCl) 0.33% sodium chloride solution is used to allow kidneys to retain the needed amounts of water and is typically administered with dextrose to increase tonicity. It should be used in caution for patients with heart failure and renal insufficiency.

20. 0.225% Sodium Chloride (0.225% NaCl) 0.225% sodium chloride solution is often used as a maintenance fluid for pediatric patients as it is the most hypotonic IV fluid available at 77 mosm /L. Used together with dextrose.

21. 2.5% Dextrose in Water (D2.5W) This solution is used to treat dehydration and decreased the levels of sodium and potassium. It should not be administered with blood products as it can cause haemolysis of red blood cells.

22. Hypertonic IV Fluids H ave a greater concentration of solutes (375 meq /L and greater) than plasma and cause fluids to move out of the cells and into the ECF in order to normalize the concentration of particles between two compartments. This effect causes cells to shrink and may disrupt their function. K nown as volume expanders as they draw water out of the intracellular space, increasing extracellular fluid volume.

23. Hypertonic Sodium Chloride IV Fluids Contain a higher concentration of sodium and chloride than normally contained in plasma. Infusion of hypertonic sodium chloride solution shifts fluids from the intracellular space into the intravascular and interstitial spaces.

24. Hypertonic Dextrose Solutions Isotonic solutions that contain 5% dextrose ( e.G. , D5NSS, D5LRS) are slightly hypertonic since they exceed the total osmolality of the ECF. U se - provide kilocalories for the patient in the short term. Higher concentrations of dextrose ( i.E. , D50W) are strong hypertonic solutions and must be administered into central veins so that they can be diluted by rapid blood flow.

25. Dextrose 10% in Water (D10W) Used in the treatment of ketosis of starvation and provides calories (380 kcal/L), free water, and no electrolytes. It should be administered using a central line if possible and should not be infused using the same line as blood products as it can cause RBC haemolysis.

26. Dextrose 20% in Water (D20W) Dextrose 20% in water (D20W) is hypertonic IV solution an osmotic diuretic that causes fluid shifts between various compartments to promote diuresis.

27. Dextrose 50% in Water (D50W) Another hypertonic IV solution used commonly is dextrose 50% in water (D50W) which is used to treat severe hypoglycemia and is administered rapidly via IV bolus.

28. COLLOIDS Colloids contain large molecules that do not pass through semipermeable membranes. Colloids are IV fluids that 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.

29. ELECTROLYTES Electrolytes are minerals in body fluids that carry an electric charge. Electrolytes affect the amount of water, the acidity of blood (PH), muscle function, and other important processes in the body.

30. SODIUM (NA+) Normal serum level 135-145 mmol/L Function Maintains extracellular function (ECF) osmolarity Influences water distribution Affects concentration, excretion and absorption of potassium and chloride Helps regulate acid-base balance Aids nerve and muscle fibre impulse transmission

31. Hyponatraemia Hypernatraemia • Fatigue • Thirst • Muscle weakness • Fever • Muscle twitching • Flushed skin • Decreased skin turgor • Oliguria • Headache • Disorientation • Tremor • Dry sticky membranes • Seizures   • Coma  

32. POTASSIUM (K+) Normal serum level 3.5 – 5.0 mmol/L Function Maintains cell electro-neutrality Maintains cell osmolarity Assists in conduction of nerve impulses Directly affects cardiac muscle contraction (repolarisation in the action potential) Plays a major role in acid-base balance Sodium – potassium gradient plays a major role in fluid balance between extracellular (ECF) and intracellular (ICF) compartments

33. Hypokalaemia Hyperkalaemia • Decreased peristalsis, skeletal muscle and cardiac, muscle function • Muscle weakness • Muscle weakness or irritability/cramps • Nausea • Decreased reflexes • Diarrhoea • Fatigue • Oliguria • Rapid, weak irregular pulse • Paraesthesia (altered sensation) of the face, tongue, hands and feet • Cardiac arrhythmias/cardiac arrest • Cardiac arrhythmias/cardiac arrest • Decreased blood pressure   • Decreased bowel motility  

34. CALCIUM (CA++) Normal serum level 2.15-2.55 mmol/L Function Enhances bone strength and durability Helps maintain cell-membrane structure, function and permeability Affects activation, excitation and contraction of sino -atrial node (intrinsic cardiac pacemaker), cardiac and skeletal muscles Participates in neurotransmitter release at synapses Helps activate specific steps in blood coagulation Activates serum complement in immune system function

35. Hypocalcaemia Hypercalcaemia • Muscle tremor • Lethargy • Muscle cramps • Fatigue • Tetany • Depression • Tonic-clonic seizures • Confusion • Parasthesia • Headache • Bleeding • Muscle flaccidity • Arrhythmias • Nausea, vomiting • Hypotension • Anorexia • Numbness or tingling in fingers, toes and around the mouth • Constipation   • Hypertension   • Polyuria   • Cardiac arrhythmias and ECG changes (shortened QT interval and widened T wave

36. CHLORIDE (CL-) Normal serum level 95-110 mmol/L Function Maintains serum osmolarity Combines with major cations to create important compounds, such as sodium chloride ( nacl ), hydrochloride ( hcl ), potassium chloride kcl ) and calcium chloride (cacl2) which contribute to acid/base and/or electrolyte balance

37. Hypochloraemia Hyperchloraemia • Increased muscle excitability • Headache, difficulty concentrating • Tetany • Drowsiness, stupor • Decreased respirations • Rapid, deep breathing (hypercapnia)   • Muscle weakness

38. PHOSPHATE (PO4) Normal serum level 0.8-1.5 mmol/L Function Helps maintain bones and teeth Helps maintain cell integrity Plays a major role in acid-base balance (as a urinary buffer) Promotes energy transfer to cells Plays essential role in muscle, red blood cell and neurological function

39. Hypophosphataemia Hyperphosphataemia • Parasthesia (circumoral and peripheral) • Renal failure • Lethargy • Vague neuro-excitability to tetany and seizures • Speech defects (such as stuttering) • Arrhythmias and muscle twitching with sudden rise in phosphate (PO4) level • Muscle pain and tenderness  

40. MAGNESIUM (MG++) Normal serum level 0.70-1.05 mol/L Function Activates intracellular enzymes; active in carbohydrate and protein metabolism Acts on myo-neural vasodilation Facilitates na + and K+ movement across all membranes Influences ca++ levels  

41. Hypomagnesaemia Hypermagnesaemia • Dizziness • Drowsiness • Confusion • Lethargy • Seizures • Coma • Tremor • Arrhythmias • Leg and foot cramps • Hypotension • Hyperirritability • Vague neuromuscular changes (such as tremor) • Arrhythmias • Vague GI symptoms (such as nausea) • Vasomotor changes • Peripheral vasodilation • Anorexia • Facial flushing • Nausea • Sense of warmth   • Slow, weak pulse