Treatment with intravenous fluids in adults

Transcription

Treatment with intravenous fluids in adults
Treatment with intravenous fluids in adults
Errors in the handling of liquids are common and have been attributed to inadequate
training and knowledge. The intravenous management of fluids is a common medical
practice and the result of the training of physicians in training must be their precise
prescription, unambiguously. However, errors in the handling of liquids are common and
have been attributed to inadequate training and knowledge. Poor fluid management can
have serious consequences, such as lung edema and severe hyponatremia resulting from
excessive fluid administration and acute renal failure caused by insufficient fluid
administration.
What is the best way to prescribe intravenous fluids?
There is a lack of good quality evidence, such as that provided by controlled and
randomized studies, to guide the management of intravenous fluids by IV Hydration In
Boston. The safe prescription of intravenous fluids requires the integration of important
clinical skills, such as knowledge of the balance of fluids, the physiology of fluids in both
normal and pathological conditions and the properties of intravenous fluids commonly
used.
Normal liquid balance
Water constitutes about 60% of the total body weight in men and 55% in women (women
have a slightly higher content). Although the distribution of body water is not uniform, it
can be considered that it occupies the intra and extracellular compartments. The
extracellular fluid is composed mainly of plasma and interstitial fluid, which are
separated by the capillary membrane.
Movement of water between the plasma and the interstitial space
The capillary endothelium is coated by the glycocalyx, a network of proteoglycans and
glycoprotein’s that separate the plasma from the subglycalic space. The movement of the
fluid through the capillaries is determined by the difference in transendothelial pressures
and the difference in colloid tic pressure between the plasma and the subglycalic space.
As a result, most of the fluid filtered from the plasma through the non-fenestrated
capillaries returns to the circulation in the form of lymph, through the interstitial
lymphatics.
Movement of water between the interstitial and intracellular spaces
 This Iv Hydration Boston is mainly determined by osmotic forces. The water
balance is regulated by the ant diuretic hormone-thirst feedback mechanism,
which is influenced by osmoreceptors and bar receptors.
 The normal hydro electrolytic balance can be greatly altered by disease and injury,
depending on non-specific metabolic responses to stress, inflammation,
malnutrition, medical treatment and organ dysfunction. For example:
 Response to stress: during the catabolic phase of this response potassium is lost
and sodium and water are retained, resulting in oliguria. Therefore, after surgery, it
is important to differentiate the oliguria caused by the (inoffensive) stress response
of oliguria caused by acute renal failure.
 Inflammatory conditions (e.g., sepsis or after trauma or surgery) and other medical
conditions (diabetes, hyperglycemia, hypervolemia) that degrade the endothelial
glycocalyx and reduce its barrier function. Thus, infused colloids can leave the
intravascular space to the compartment of the interstitial fluid, reducing its
volume-expanding effect and contributing to interstitial edema.
 Malnutrition: can lead to overload of sodium and water and depletion of
potassium, phosphate and magnesium. In malnourished patients, intravenous
glucose can precipitate pulmonary edema and cardiac arrhythmias.