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IV FLUIDSPresented By

DR.SAQBA ALAMBDS-FCPS (I) ORAL AND MAXILLOFACIAL SURGERY

INTRAVENOUS THERAPY OR IV THERAPYIntravenous therapy also referred as IV therapy constitutes the administration of liquid substances directly into a vein and the general circulation through venepuncture (Mosby 1998)

REASONS FOR INFUSION:A/c to Brooker(2007) and Martin (2003) Intravenous fluid therapy may be used to:

Replace fluids and replace imbalances.Maintain fluid, electrolyte and acid-base balance.Administer blood and blood productsAdminister medicationProvide parenteral nutritionMonitor cardiac functionImmediate resultsTo provide avenue for diagnostic testingPredictable therapeutic effectsThere are more than 200 types of commercially prepared IV fluids.

TYPES OF IV FLUIDS:

CRSTALLOIDS COLLOIDS

CRYSTALLOIDS:

Isotonic, Hypotonic and Hypertonic

ISOTONIC SOLUTIONS INDICATIONS:Isotonic solutions contain electrolytes such as Nacl,KCL,Cacl and sodium lactate.

Indicated in the treatment of vascular dehydration, replaces sodium and chloride.

5%D/W is isotonic when infused but becomes hypotonic when dextrose has been metabolized.

Use cautiously in patients who are fluid-overloaded or who would be compromised if vasscular volume would increase such as renal and cardiac patients.

ISOTONIC FLUIDS AND THEIR USES:ShockResuscitationFluid challengesBlood transfusionsMetabolic alkalosisHyponatremiaDKA

Use with caution in patients with heart failure,edema,or hypernatremia.

Can lead to fluid overload.

DehydrationBurnsGI tract fluid lossAcute blood lossHypovolemia

Contains potassium, can cause hyperkalemia in renal patients.

Patients with liver disease cannot metabolize lactate.

Lactate is converted into bicarb by liver.

Fluid loss and dehydration

Hypernatremia

Solution becomes hypotonic when dextrose is metabolized

Do not use for resuscitation

Use cautiously in renal and cardiac patients

0.9% NaclLactated RingersD5W

HYPOTONIC SOLUTIONS INDICATIONS (8mmol/L per day)

Acute decrease in serum sodium below 125mmol/L with neurological symptoms should be considered a medical emergency and should include prompt control of serum sodium concentration.

Rapid correction of chronic or asymptomatic hyponatremia is not indicated.

Acute increase in serum sodium above 150 mmol/L should be assessed for a cause and correctedDiabetes insipidus is important to recognize as it can cause large rapid losses of free water with a rapid rise in serum Na concentrationIn either hypo or hypernatremia,the rate of correction should be proportional to the rate of onset of hypernatremia taking into account the presence and severity of neurological symptoms.Overly rapid correction may result in cerebral oedema,seizures or death!

REFERENCES:Andrew K Hilton and et al,MJA(Medical journal of Australia) Avoiding common problems associated with IV therapy.

Ann Crawford PhD,RN,Helene Harris MSN,RN (Lippincot Nursing Center)IV fluids-what nurses need to know.

Algorithims for IV fluid therapy in adults,(NICE clinical guidelines Dec 2013)