We're just getting into the basics of fluid replacement IV therapy. One thing I'm having difficulty understanding is the dynamic of hypervolemia treatment. Since hypervolemia is an excess in isotonic fluid, then would you introduce any IV fluid at all before diuresing? I've heard two different schools of thought. One: do not give a fluid at all; 2: give a hypertonic solution which would take fluid off the tissues. Which is correct and could you give me your rationale? Would you believe this is my spring break, it's a beautiful day, I live across the street from a south Florida beach and I'm worrying about this stuff?
Mar 6, '04
Quote from malenurse1
This is so cool, we just went over this in pathophys this week! With fluid volume excess you already have edema so you want to move the fluid from the interstitial space to the intravascular space in order for diruretics to be effective. Remember, you want the kidneys to do their job before resorting to artificial means of diuresis. Your patient is likely going to be hypernatrimic, so the IV fluid of choice would be D5W. You want to give potassium sparing diuretics to protect from the associated hypokalemia.
I hope this is right or I'm gonna fail next weeks pathophys test on fluid volume and electrolytes!
For what its worth...take your books to the beach!
Well... hmm. Me thinks its time to really talk this thing out. The patient is hypervolemic which is an isotonic
situation. Hypernatremia would indicate a hypertonic situation in the ECF which is not the same as hypervolemia. Please correct me if I'm wrong because this is new stuff to me. So if you put D5W (isotonic) fluid in the intravascular space, then you have no fluid shift and the situation remains the same except you have introduced more fluid and worsened the condition. If you introduce hypotonic solution, then the cells will hemolyze and you essentially drown your patient. If you use hypertonic, all fluids will go into the intravascular space which will decrease cardiac output and you have CHF. On the other hand, if you get the fluid into the vasculature and off the tissues and diurese simultaneously, then that might get us to where we want to go? Now I'm assuming (bad thing) that in hypervolemia, you're going to have degrees. When it reaches the point of pulmonary edema, the ABC's will tell us priority number one is to get the fluid off the lungs so maybe the hypertonic solution, at that point, might be the right thing to do. However, before it gets to that point, perhaps just restricting the fluids and using a loop diuretic might do the job. Any more thoughts? This is really important and interesting stuff.
Last edit by wonderbee on Mar 6, '04