Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
• Osmolality:
particle content per liter of
water (mOsm/L)
• Normal osmolality in the
plasma: 285-290 mOsm/L
Definitions
• Intracellular: fluid within the cell
• Extracellular: fluid outside the cell but in the
interstitial space and intravascular
• Interstitial: fluid between the cells – in the
spaces between tissues
• Intravascular: within the vessels
Transport of Fluid
• Diffusion: the movement of molecules through a
semipermeable membrane from a high concentration to a
low concentration
• Osmosis: the one way passage of water through a
semipermeable membrane from a low concentration of
particles to a high concentration of particles
• Filtration: fluid going through a filter under pressure or
passage through a material that prevents passage of certain
molecules
• Active transport: Electrolytes move from a low
concentration to a high concentration by moving against
the concentration gradient. ATP provides energy needed to
do this.
Fluid Imbalance
Fluid imbalance can arise due to:
• Hypovolemia dehydration:
Prescipitating factors: fasting, vomiting,
nausea, diarrhea, acute blood loss
• Hypervolemia: fluid overload:
Isotonic, colloid, plasma/blood >>
• Water intoxication: hypotonic >>
IV Fluid Therapy
Indications:
• Diarrhea:
– Severe dehydration
– Diarrhea is accompanied by severe uncontrolled vomiting
– Inability to comply with oral fluids
• Other:
– Hemorrhage
– Shock
– Electrolyte disturbance
– Supplying fluids and food for patients who are unable to
maintain oral intake
– Later on the fluid therapy is adjusted according loss in
stool and sweat
Uses of IV Therapy
• Maintain fluid and/or electrolyte balance, optimal
perfusion
• Administer medication continuously or intermittently
• Administer bolus medication
• Administer fluid to maintain venous access in case of an
emergency
• Administer blood or blood products
• Administer IV anesthetics
• Maintain patient’s nutritional status
• Administer diagnostic reagents
• Monitor haemodynamic functions
• Correct acidosis or alkalosis
Evaluation of Intravascular Volume
• Physical Examination
IV Therapy
• Intravenous fluid therapy may consist of
infusions of crystalloids, colloids, or a
combination of both
IV Therapy
• Types of IV fluids: • Distribution of IV Fluid
– Crystalloids: RA, RL, NaCl
0,9%
– Colloids: plasma,
albumin, dextran,
gelatin, strach
– Blood and blood
products
IV Therapy (cont.)
• Crystalloids
– Crystalloids are water with electrolytes that form a
solution that can pass through semipermeable
membranes
– Lost rapidly from the intravascular space into the
interstitial space. Remain in the extracellular
compartment for about 45 minutes
– Larger volume than colloids are required
– Water from crystalloids diffuses through the ICF
IV Therapy (cont.)
• Crystalloids
– Hypertonic (>300mOsm/L)
Draws fluid into the
intravascular compartment
from the cells & the interstitial
compartments
– Hypotonic (<280mOsm/L)
Shifts fluid out of the
intravascular compatment,
hydrating the cells and the
interstitial compartments
– Isotonic (280-300 mOsm/L)
Isotonic solution stays in the
intravascular space expands
the intravascular compartment
IV Therapy (cont.)
• Common crystalloid
IV Therapy (cont.)
• Colloids
– Contain solutes in the form of large proteins or
other similar sized molecules
– Cannot pass through the walls of capillaries and
into cells
– Remain in blood vesselslonger and increase
intravascular vol
– Attract water from the cells into the blood vessels
– Prolonged movement can cause the cells to lose
too much water & become dehydrated
IV Therapy (cont.)
• Common Colloids
IV Therapy (cont.)
• Blood and Blood Products
Maintenance Therapy
• Goals of maintenance fluids:
– Prevent dehydration
– Prevent electrolyte disorders
– Prevent ketoacidosis
– Prevent protein degradation
ie. 24 kg child
(4 ml X 10kg)+ (2 ml X 10kg) + (1 ml X 4kg) = 64
ml/hr