Terapi cairan infus ( RL, NaCl, Dextrose, Albumin, Dextran, Gelatin, HES, KCL, Kabiven)

Summary

This video script explains the principles and types of fluid therapy used in medical treatments, specifically focusing on intravenous (IV) solutions. It distinguishes between two categories: resuscitation fluids for acute fluid loss and maintenance fluids for long-term body fluid balance. The script discusses crystalloid and colloid solutions, their advantages and drawbacks, and their clinical applications, such as normal saline, Ringer's lactate, and albumin. It also covers the correction of electrolyte imbalances like hypokalemia and hyponatremia, with examples of how specific IV solutions are used for managing these conditions, including sodium chloride and potassium chloride solutions.

Takeaways

• 😀 Resuscitation fluids are used to replace lost body fluids quickly during acute dehydration or blood loss.
• 😀 Maintenance fluids are designed to maintain the body's fluid and electrolyte balance in patients unable to eat or drink.
• 😀 Crystalloid solutions (like Normal Saline, Ringer's Lactate, and D5) are commonly used for both resuscitation and maintenance, as they are inexpensive and non-toxic.
• 😀 Crystalloid solutions are characterized by their small molecules dissolved in water, with types classified as isotonic, hypotonic, or hypertonic.
• 😀 Colloid solutions contain larger molecules and are used for volume expansion, with examples including albumin, dextran, and hydroxyethyl starch (HES).
• 😀 Albumin is a plasma expander used to correct hypovolemia and shock, and it remains in the bloodstream for an extended period (16 hours).
• 😀 Dextran is another colloid used for hypovolemic shock but requires caution due to the risk of bleeding complications.
• 😀 Sodium chloride (NaCl) and potassium chloride (KCl) are commonly used to correct electrolyte imbalances like hyponatremia and hypokalemia.
• 😀 Potassium chloride (KCl) is critical for correcting low potassium levels, especially in patients on loop diuretics, but must be monitored to avoid hyperkalemia.
• 😀 The correct selection of fluid therapy depends on the patient’s condition, with attention to specific electrolytes and potential complications like acidosis or alkalosis.

Q & A

What is the primary difference between resuscitation fluids and maintenance fluids?

Resuscitation fluids are designed to replace acute fluid losses in the body, such as during dehydration, while maintenance fluids are used to maintain long-term fluid and electrolyte balance in patients who cannot consume nutrients or fluids orally.

What are crystalloid solutions and how do they function?

Crystalloid solutions contain small organic and inorganic molecules dissolved in water. They function by distributing across various body compartments, including the interstitial space. Examples include Normal saline, Ringer’s lactate, and Dextrose 5%.

What are the advantages of crystalloid fluids?

The advantages of crystalloid fluids include being non-toxic, inexpensive, safe to use, and readily available. They also do not cause significant reactions as the solvent is water.

What are the disadvantages of crystalloid fluids?

The primary disadvantage of crystalloid fluids is that they have a limited ability to remain in the intravascular space, which means they are quickly excreted and may not be effective for long-term volume expansion.

What are colloid fluids and why are they used?

Colloid fluids contain larger molecules, such as proteins or starches, which tend to remain in the intravascular space longer. They are used to expand plasma volume more effectively than crystalloid fluids and are particularly useful in patients with hypovolemia or plasma protein deficiencies.

Can you provide an example of a colloid fluid and its use?

One example of a colloid fluid is Albumin, which is used to restore plasma volume in patients with conditions such as edema, liver failure, or acute blood loss. It remains in the intravascular space for longer periods, improving fluid balance.

What are some common electrolyte imbalances that require fluid therapy?

Common electrolyte imbalances that require fluid therapy include hypokalemia (low potassium levels) and hypernatremia (high sodium levels). These imbalances are corrected using specific fluids containing the necessary electrolytes, such as Potassium chloride (KCl) for hypokalemia and Sodium chloride (NaCl) for hypernatremia.

How is potassium corrected in the body using intravenous fluids?

Potassium is corrected by administering Potassium chloride (KCl). The formula used for correction is: (Desired Potassium level - Current Potassium level) × 0.3 × Body weight (kg). This helps to calculate the appropriate dosage for restoring potassium balance.

What are the potential complications of using too much saline or Ringer’s lactate solution?

Excessive use of saline (NaCl) may lead to hyperchloremic acidosis, potentially raising blood pressure, while excessive use of Ringer’s lactate can cause metabolic alkalosis due to the increased production of bicarbonate from lactate metabolism.

What types of fluids are used for patients who require long-term nutritional support but cannot eat?

For patients who require long-term nutritional support, fluids containing carbohydrates, amino acids, and fats are used. These include products like Aminofluid and Aminoleban, which provide essential nutrients to maintain body functions when oral intake is not possible.