Part 3 Medication Administration Body Fluid Composition EMS 353 Lecture 8 Dr. Maha Khalid.

Part 3 Medication Administration

Body Fluid Composition

EMS 353 Lecture 8

Dr. Maha Khalid

Contents ……

Body Fluid Composition

Electrolytes.

Abnormal States of Fluid and Electrolyte Balance.

IV Fluid Composition .

IV solution .

Purpose of IV Solutions

Pre hospital Fluids :

Lactated Ringer’s

Normal saline solution

5% dextrose in water .

8. Other fluids

9. Packaging of IV Fluids

Body Fluid Composition

Total body water (TBW) is 60% of adult weightIntracellular fluid (ICF): 45% Extracellular fluid: 15%

Interstitial fluid Intravascular fluid

Fluids are composed of solutions (solvent and solute).

Interstitial fluid (or tissue fluid) is a solution that bathes and surrounds the cells of multicellular animals. It is the main component of the extracellular fluid, which also includes plasma and transcellular fluid. The interstitial fluid is found in the interstitial spaces, also known as the tissue spaces.

Body Fluid Composition

ElectrolytesCarry charges

Reactive and dangerous if left to circulateWater stabilizes electrolytes charges.

Cation: positively charged

Anion: negatively charged

Body Fluid Composition

Electrolytes (cont’d)Measured by milliequivalent

(mEq)1 mEq of a cation can react

completely with 1 mEq of an anion.

Singly charged: monovalent Doubly charged: bivalent

Electrolytes

Mg

NaK

Ca

Cl

Electrolytes

Add Your TextBicarbonate

Phosphorus

Sodium

• Regulates distribution of water

Potassium

• Major role in neuromuscular function and conversion of glucose into glycogen

Sodium-potassium pump

• Helped by insulin and epinephrine• Hypokalemia: low serum levels • Hyperkalemia: high serum levels

Calcium

• needed for bone growth • Hypocalcemia: low serum

levels• Hypercalcemia: high serum

levels

Magnesium

• metabolizes proteins and carbohydrates.

Bicarbonate:

• determines metabolic acidosis and alkalosis

Chloride

• regulates the pH of the stomach

Phosphorus

• important component in adenosine triphosphate (ATP)• ATP: the body’s energy

source

metabolic acidosis

In medicine, is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due to increased production of hydrogen ions by the body or the inability of the body to form bicarbonate (HCO3-) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it is one of the two general causes of acidemia

Metabolic alkalosis

Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range ( 7.35-7.45 ). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations

Abnormal States of Fluid and Electrolyte Balance:

A healthy body maintains a balance between intake and output of fluids and electrolytes. Homeostasis: internal environment’s

resistance to change

A healthy person loses approximately 2 to 2.5 L of fluid daily.

Abnormal States of Fluid and Electrolyte Balance

Dehydration is an inadequate total systemic fluid volume.Causes:

Diarrhea

Vomiting

Gastrointestinal drainage

Infections

Metabolic disorders

Abnormal States of Fluid and Electrolyte Balance

Over hydration occurs when the body systemic fluid volume increases.

Causes:Unmonitored IVs

Kidney failure

Water intoxication in endurance sports

Prolonged hypoventilation

© Medical-on-Line/Alamy Images

IV Fluid Composition

Each bag of IV solution is individually sterilized.Altering IV

concentration can move water into or out of fluid compartment

IV solution

CrystalloidColloid

clear fluids made up of water and electrolyte solutions;

Will cross a semi-permeable membrane e.g Normal, hypo

and hypertonic saline solutions; Dextrose

solutions; Ringer’s lactate and Hartmann’s solution.

Gelatinous solutions containing particles suspended in solution. These particles will not form a

sediment under the influence of gravity and are largely unable

to cross a semi-permeable membrane. e.g. Albumin,

Dextrans, Hydroxyethyl starch [HES]; Haemaccel and

Gelofusine

Blood Volume–Expanding Solutions

• Crystalloid solutions– Isotonic: Same tonicity as human blood– Examples: Normal saline, lactated Ringer’s– Hypotonic: Lower concentrations of

electrolytes than blood – Hypertonic: Higher concentrations of

electrolytes than blood • Colloid solutions

– Use undergoing debate

Purpose of IV Solutions

Replacement of Lost Fluids (vomiting, diarrhea, dehydration)

Maintenance of Fluid and Electrolyte Balance

(NPO patients)

Prehospital Fluids

Lactated Ringer’sNormal saline solution5% dextrose in water

Other FluidsBloodOxygen-carrying solutions

Perfluorocarbons

Hemoglobin-based oxygen-carrying solutions (HBOCs)PolyHeme

Hemopure

1) 0.9% Normal Saline

• Think of it as ‘Salt and water’• Principal fluid used for intravascular

resuscitation and replacement of salt loss e.g diarrhoea and vomiting

• Contains: Na+ 154 mmol/l, K+ - Nil, Cl- - 154 mmol/l; But K+ is often added

2) Lactated Ringer's solution

• is a solution that is isotonic with blood and intended for intravenous administration. It may also be given subcutaneously. Lactated Ringer's solution is grouped with intravenous fluids known as "crystalloids" – which include saline and dextrose solutions

3) 5% Dextrose

Think of it as ‘Sugar and Water’Primarily used to maintain water balance in patients who are not able to take anything by mouth

Packaging of IV Fluids

Most packaged in soft plastic or vinyl bags

Container provides important information: Label lists fluid type and expiration date

Medication administration port

Administration set port

IV Solution Containers

Do not use any IV fluids after their expiration date; any fluids that appear

cloudy, discolored, or laced with particulate; or any fluid whose sealed

packaging has been opened or tampered with.