Chapter Fourteen: Hypovolemic States, part 2

Outline Chapter 14 — Treatment

- Treatment

- Both oral and IV treatment can be used for volume replacement

- The goal of therapy are to restore normovolemia

- And to correct associated acid-base and electrolyte disorders

- Oral Therapy

- Usually can be accomplished with increased water and dietary sodium

- May use salt tablets

- Glucose often added to resuscitation fluids

- Provides calories

- Promotes intestinal Na reabsorption since there is coupled Na and Glucose similar to that seen in the proximal tubule

- Rice based solutions provide more calories and amino acids which also promote sodium reabsorption

- 80g/L of glucose with rice vs 20 g/L with glucose alone

- IV therapy

- Dextrose solutions

- Physiologically equivalent to water

- For correcting hypernatremia

- For covering insensible losses

- Watch for hyperglycemia

- Footnote warns against giving sterile water

- Saline solutions

- Most hypovolemic patients have a water and a sodium deficit

- Isotonic saline has a Na concentration of 154, similar to that of plasma see page 000

- Half-isotonic saline is equivalent to 550 ml of isotonic saline and 500 of free water. Is that a typo?

- 3% is a liter of hypertonic saline and 359 extra mEq of Na

- Dextrose in saline solutions

- Give a small amount of calories, otherwise useless

- Alkalinizing solutions

- 7.5% NaHCO3 in 50 ml ampules 44 mEq of Na and 44 mEq of HCO3

- Treat metabolic acidosis or hyperkalemia

- Why 44 mEq and not 50?

- Do not give with calcium will form insoluble CaCO3

- Polyionic solutions

- Ringers contains physiologic K and Ca

- Lactated Ringers adds 28 mEq of lactate

- Spreads myth of LR in lactic acidosis

- Potassium chloride

- Available as 2 mEq/mL

- Do not give as a bolus as it can cause fatal hyperkalemia

- Plasma volume expanders

- Albumin, polygelastins, hetastarch are restricted to vascular space

- 25% albumin can pull fluid into the vascular space

- 25% albumin is an albumin concentration of 25 g/dL compare to physiologic 4 g/dL

- Says it pulls in several times its own volume