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

2. 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

3. Body Fluid Composition  Total body water (TBW) is 60% of adult weight  Intracellular fluid (ICF): 45%  Extracellular fluid: 15%  Interstitial fluid  Intravascular fluid  Fluids are composed of solutions (solvent and solute).

4.  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.

5. Body Fluid Composition  Electrolytes  Carry charges  Reactive and dangerous if left to circulate  Water stabilizes electrolytes charges.  Cation: positively charged  Anion: negatively charged

6. 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

7. Electrolytes Mg Na K Ca Cl Electrolytes Add Your Text Bicarbonate Phosphorus

8. 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

9. Calcium needed for bone growth Hypocalcemia: low serum levels Hypercalcemia: high serum levels Magnesium metabolizes proteins and carbohydrates.

10. 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

11. 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

12. 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

13. 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.

14. Abnormal States of Fluid and Electrolyte Balance  Dehydration is an inadequate total systemic fluid volume.  Causes:  Diarrhea  Vomiting  Gastrointestinal drainage  Infections  Metabolic disorders

15. 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

16. IV Fluid Composition  Each bag of IV solution is individually sterilized.  Altering IV concentration can move water into or out of fluid compartment

17. IV solution Crystalloid Colloid 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

18. 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

19. Purpose of IV Solutions  Replacement of Lost Fluids ( vomiting, diarrhea, dehydration)  Maintenance of Fluid and Electrolyte Balance (NPO patients)

20. Prehospital Fluids  Lactated Ringer’s  Normal saline solution  5% dextrose in water

21. Other Fluids  Blood  Oxygen-carrying solutions  Perfluorocarbons  Hemoglobin-based oxygen-carrying solutions (HBOCs)  PolyHeme  Hemopure

22. 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 solutionsisotonicbloodintravenous administrationsubcutaneouslycrystalloids salinedextrose

23. 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

24. 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

25. IV Solution Containers

26. 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.