Download IV infusions…..

INTRAVENOUS Fluids
Presented By
Muhammad Suleman Raza
INTRODUCTION
The goal of intravenous fluid administration is to carefully achieve and
maintain a euvolemic and isotonic environment within the body as well
as to provide for a variety of nutritional and pharmacologic interventions.
The selections of an appropriate IV solution is dependent upon the fluid
volume and electrolyte status of the individual patient.
Na concentration in Body fluids
Body Fluid
Concentration
serum
135-145 mEq/L
Saliva
10-55mEq/L
Gastric juice
10-100mEq/L
Pancreatic juice
120-140mEq/L
Bile
120-160mEq/L
Intestinal
105-145mEq/L
Stool/diarrhea
1-100mEq/L
Skin
1-80mEq/L
Na distribution in Body
Compartment or Tissue
Na Distribution
Plasma
11%
Interstitial
29%
Connective Tissues
12%
Bone
Exchangeable
Non-Exchangeable
14%
29%
Intracellular
2.5%
Transcellular
2.5%
Total
100%
Water distribution in body
Cont….
General Recommendations For IV
Fluid Selection
Hyponatremia with Hypovolemia
 Decreased total body water and Na ,Relatively greater decrease in Na
 External losses
 GI : vomiting ,Diarrhea, fistulas ,ostomies
 Third-space loses : Pancreatitis, peritonitis ,small-bowel obstructions ,
Rhabdomyolysis , Burns , Post operative period.
 Renal loses:
 Diuretics.
 Osmotic diuresis.
 Mineralocorticoid deficiency.
 Salt- losing Naphropathies.
Cont…
Hypernatremia with Hypovolemia
 Decreased TBW and Na ; relatively greater decrease in TBW.
 External losses.
 GI: vomiting ,Diarrhea.
 Skin : Burns , excessive sweating.
 Renal losses.
 Diuretics medications.
 Osmotic Diuresis.
Cont…
Hypernatremia with Euvolemia
 Relatively decreased TBW ; increased Total body Na.
 Inability to access free water.
 Patients on tube feeding.
 Can’t reach water glass.
 NPO on isotonic IV fluids only.
Cont….
Hypernatremia with hypervolemia
Increased TBW; greater increase in Na.

Hypertonic IV fluid administration without free water.

Total parental nutrition with inadequate free water.

Mineralocorticoid excess.
Type of IV solution
Type of IV solution
Isotonic
Hypotonic
Hypertonic
Isotonic solution

A solution that has the same salt concentration as the normal cells of
the body and the blood.

Ex:
1- 0.9% NaCl .
2- Ringer Lactate .
4- D5W.
Hypotonic solution
A solution with a lower salts concentration than in normal cells of the
body and the blood.

EX:
1-0.45% NaCl .
2- 0.33% NaCl .
Hypertonic solution:
• A solution with a higher salts concentration
than in normal cells of the body and the
blood.
 Ex:
• D5W in normal
Saline solution .
• D10W.
Categories of intravenous solutions
according to their purpose:
• Nutrient solutions.
• Electrolyte solutions.
• Volume expanders.
Nutrient solutions.
•
It contain some form of carbohydrate and water.
•
Water is supplied for fluid requirements and carbohydrate for
calories and energy.
•
They are useful in preventing dehydration and ketosis but do not
provide sufficient calories to promote wound healing, weight gain,
or normal growth of children.
•
Common nutrient solutions are D5W and dextrose in half-strength
saline.
Electrolyte solutions
(Crystalloid)
•
•
fluids that consist of water and dissolved crystals,
such as salts and sugar.
Used as maintenance fluids to correct body fluids and
electrolyte deficit .
• Commonly used solutions are:
-Normal saline
(0.9% sodium chloride solution).
-Ringer’s solutions
(which contain sodium, chloride, potassium, and calcium.
-Lactated Ringer’s solutions
(which contain sodium, chloride, potassium ,calcium and
lactate) .
Volume expanders (Colloid)
 Are used to increase the blood volume following
severe loss of blood (haemorrhage) or loss of
plasma ( severe burns).
 Expanders present in dextran, plasma, and albumin.
Parenteral Nutrition (PN)
 Parenteral nutrition is a form of nutritional
support that supplies protein, carbohydrate, fat,
electrolytes , vitamins, minerals, and fluids via
the IV route to meet the metabolic functioning of
the body.
IV Infusion Method
I.V. Bolus
(I.V. push)
IV
Infusion
Method
Intermittent
infusion
Continuousdrip
infusion
Electrolyte content of IV solutions per Liter
Fluid
Na
K
Glucose
Tonicity
Mosm/liter
0.9 NS*
154
0
0
Slightly
Hypertonic
304
0.45 NS*
77
0
0
Hypotonic
154
0.25 NS*
38
0
0
Hypotonic
77
Lactated
Ringers (LR)
130
4
0
Isotonic
280
D5W
0
0
50gm
Hypotonic
0**
D5W 0.45
NS*
77
0
50gm
Hypotonic
154**
0.9 NS+150
mEq
NaHCO3
308
0
0
Very
Hypertonic
616
Hypertonic
Solutions
Content (mEq/L)
Clinical Implication
Dextrose 5% in 0.45% NS*
77 Na ,77 Cl
Daily maintenance of body fluid and
nutrition.
Dextrose 5% in 0.9% NS*
154 Na , 154 Cl
Fluid replacement of Na ,Cl and calories
(170)
Dextrose 10% in 0.9% NS*
154 Na , 154 Cl
Fluid replacement of Na ,Cl and calories
(340)
Dextrose 5% in Lactated
Ringer
130 Na,4 K,109 Cl,
28 lactate, 3Ca2+
Resembles the normal composition of
Blood, serum and plasma K+ level below
bodies daily requirement caloric value
(180)
General Recommendations For IV Fluid Selection
Achieving Euvolemia
Determine the pt. volume status
estimate if any ,the degree of
variation from euvolemia
If euvolemic ,only maintenance
fluids need to be prescribed, as in
pt. who may be NPO.
The dehydrated pt. will require an
estimated amount of isotonic fluid
to bring them to normal volume
status
Volume replacement because of
additional clinical volume loss like NG
suction, diarrhea, Blood loss Measure
I/O VOLUME BODY WEIGHT AND Na
content of specific fluid loss
Achieving Isotonicity
Tonicity of body fluids can be measured
directly (serum osmolality) , or estimated
approximately from the serum sodium
concentration ([Na]x2 +10) or more exactly
from the formula [Na]x2+glucose/18
The isotonic pt. requires only maintenance
Na replacement unless they are also
dehydrated
The hypertonic (Hypernatremic) pt. requires
additional free water replacement .
Average TBW=0.66 X body weight.
Water Deficit=TBW x[serum Na – 140]/140
Conclusions
 Achievement and maintenance of a euvolemic and isotonic internal
environment requires careful adjustment of water and Na intake
that reflects the excesses or deficits of these physiologically linked
nutrients.
 Optimal care of fluid status of an individual also requires an
appreciation of the limits of Na and water handling which can vary
from pt. to pt depending upon such factors as Age, Renal and
Cardiac function and variations in their otherwise routine intake of
Na.
 Standard assessment method include physical examination, serum
Electrolytes, and accurate body weight and fluid intake and output
measurements.
References

Androgue HJ,Madias NE. Hyponatremia ,NEJM,2000;342(21):1581-1589

Simpson FO. Sodium intake, body sodium and sodium
excretion.Lancet,1988;7(2):25.

http://www.medterms.com/script/main/art.asp?articlekey=3870

-Carol.T.taylor and carol lillis.R, (2001): Fundamentals of Nursing, 4th ed
,Lippincott, company,Pheladelphia ,pp:180-249.