Pharm lec 6.docx - Fluid and Electrolyte Replacement Acute...

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Fluid and Electrolyte Replacement Acute Care Enteral replacement of fluids Restriction of fluids Parenteral replacement of fluids and electrolytes (IV) o TPN For strict L/T NPO o Crystalloids (electrolytes) Small particles that pass freely via semi permeable membrane o Colloids (blood/blood components) Lg proteins that cant pass through membrane Why fluid restrictions o Low Na, lots of fluid o Pt gets 50% of fulids on 1 st shift and the other 50% on 2 nd /3 rd shift o Who? Pt with renal failure, CHF IV Therapy IV therapy: crystalloids o Isotonic o Hypotonic o Hypertonic Colloids Lipids Blood/blood products Who needs fluids? o Pt with blood loss, fluid loss via evaporation (in surgery), pt vomits, diarrhea, excessive sweat, any kind of excess sweat
Isotonic Hypotonic Hypertonic Same osmolality as plasma/ECF Inc intravascular fluid volume No shift Ex. 0.9% NaCl, LR, D5W (Sugar in H20) Same saltyness as blood Gives fluid to cells For pt who lost blood r/t trauma, surgery, dehydration Maintains intravascular fluid Helps to inc BP Only fluid that can be given as a bolus ( crash BP, septic) Not for pt with intracranial pressure Lesser concentration than plasma Water moves into the cells Ex. 0.45% NaCl, 0.33%NaCl, 2.5%D Cell=swell Less salty than blood For pt who undergoes surgery, receive IV, cells still need nutrients Rapid infusion can cause cell lysis due to swelling Contraindicated in patients with inc of intracranial pressure Hypo=hippo Used for intracellular dehydration (DKA, Hyperosmolar hyperglycemic state) Provides free water Risk of depleting intravascular volume

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