IV Fluids

IV FLUIDS

IV Fluids – Introduction

• Chemically prepared solution– Solvent= water– Solutes= material (sodium, potassium, chloride; and

other larger compounds like proteins/molecules)

• Tailored to the body’s needs• To replace lost fluids and/or aid in the delivery of

IV medications• Have different forms & different impacts on the

body

Phase of fluid therapy

• Emergency phase– Returning the patient's status to normal (deficit

volume)• Replacement phase– Replacing normal ongoing losses (maintenance

volume)• Maintenance phase– Replacing continuing abnormal losses (continuing

losses volume)

TBW = Total Body Water

Trancellular fluids: CSF, pleural fluid, peritoneal fluid, intra ocular fluid, synovial fluid Plasma is intravascular fluidInterstitial fluids: tissue

fluids and lymph fluid

Normal body fluid loss

• Urine (50%)– Normal: 50 ml/ kgBB/ 24 jam

• Insensible Water Loss (50%)– Respiration (15%)– Skin (30%)– Feces (5%)

The Fluid’s Tonicity

• HypertonicTonicity > plasma

• IsotonicTonicity = plasma

• HypotonicTonicity < plasma

Tonicity: concentration of electrolytes dissolved in the water, compare with body plasma

The Fluid Tonicity Comparison

IV Fluids different forms

• Colloids• Crystalloids• Blood and blood products

Colloid versus Crystalloid

Colloid solutions• Large proteins/molecules• Remain in the blood vessels• Attract water from cells into

blood risk of dehydration• Used for maintaining blood

volume• Expensive• Common solutions:

– Plasma protein fraction– Dextran– Hetastarch

Crystalloid solutions• Contain electrolytes, but lack

of large proteins /molecules• Have tonicity as patient’s

need• In 1 hr 2/3 will leave blood

vessels risk of fluid effusion • Used mainly for pre-hospital

setting & maintanance• More available and afordable• Common solutions:

– Lactated Ringer’s– Normal saline solution (NaCl)– D5

Label of IV fluid container

• Type of IV fluid (name & type of solutes contained within)

• Amount of IV fluid (mL)• Expiration dates

RINGER LACTAT, RINGER ASERING, HARTMANN’S SOLUTIONComposition RL

(Ringer Lactate)

Asering® (Ringer Acetate)

Hartmann’s solution (compound sodium lactate)

Na+ 130 130 131

Cl- 109 108.7 111

K+ 4 4 5

Ca++ 3 2.7 4

Acetate 28 28 29

Information Good for liver problems because acetate is metabolized in muscle

Contra-indicated to diabetes patients because of isomers of lactate is glucogeogenic

KAEN ® KAEN 1B KAEN 3A KAEN 3B KAEN 4A KAEN 4B

CompositionSodium (Na++)Potassium (K+)Chloride (Cl-)DextroseLactate

38.5

38.537.5 gr/L

60105027 gr/L20

5020502720

30-204010

3082837.510

Fluid requirements for adult

• Daily maintenance fluid requirements vary between individuals.– 70 Kg male = 2500 – 3000 ml/day water, 120 –

140 mmol sodium and 70 mmol potassium– 40 Kg woman = 2000 ml/day, 70 – 90 mmol

sodium and 40 mmol potassium

Fluid requirements• By BSA (Body Surface Area) = mL/ m2/ 24 hr– Appropriate for BW > 10 kg– Normal for maintenance fluid is 1500 ml/ m2/ 24 hr

• By body weight (Global formula):– 100 ml/ kg – first 10 kg– 50 ml/ kg – second 10 kg– 20 ml/ kg – BW > 20 kgEx: a child with BW 25 kg, needs

100 ml/ kg x 10 kg = 1000 cc – 10 kg (I) 50 ml/ kg x 10 kg = 500 cc – 10 kg (II)20 ml/ kg x 5 kg = 100 cc – 5 kg (cont.)

Total = 25 kg = 1600 cc/ 24 hr

Fluid requirements for children

• By Darrow – <3kg : 175cc/kg/day– 3-10kg : 105 cc/kg/day– 10-15kg : 85cc/kg/day– >15kg : 65 cc/k/day

• By Holiday and Segard– 10 kg (I) : 4 cc/kg/hr– 10kg (II) : 2cc/kg/hr– 10 kg (III) : 1 cc/kg/hr

Things will change fluid requirements• Increase metabolism:– Fever will ↑ H2O: 12%/ °C

• Decrease metabolism:– Hypotherm will ↓ H2O 12%/ °C