Question about IV therapy

[EmilyEmily]

please dont bite my head off.

if someone has low hemoglobin, and we want to increase circulating blood volume would it be correct to give them a hypertonic solution?

[TrevyRN, BSN, RN]

Lol @ "per say"... it's late! I meant per se... don't bite my head off, heheh.

[Esme12, ASN, BSN, RN]

Almost all circulatory shock states require large-volume IV fluid replacement, as does severe intravascular volume depletion (eg, due to diarrhea or heatstroke). Intravascular volume deficiency is acutely compensated for by vasoconstriction, followed over hours by migration of fluid from the extravascular compartment to the intravascular compartment, maintaining circulating volume at the expense of total body water. However, this compensation is overwhelmed after major losses. See Fluid Metabolism for maintenance fluid requirement discussion, and see Dehydration and Fluid Therapy in Children for mild dehydration discussion.

Fluids

Choice of resuscitation fluid depends on the cause of the deficit.Intravenous Fluid Resuscitation: Shock and Fluid Resuscitation: Merck Manual Professional

http://www.anwresidency.com/students/talks/IVF_lytes.pdf

Nursing Center - CE Article

IV fluids: Do you know what's hanging and why? | Modern Medicine

not that I am a big wiki fan...this is pretty good.

Intravenous therapy - Wikipedia, the free encyclopedia

Third-spacing: Where has all the fluid gone?

Attached Files

• Chart of Commonly Transfused Blood Products.doc (29.0 KB, 171 views)
  
• IVchart.pdf (33.1 KB, 4644 views)
  
• Table of Commonly Used IV Solutions.doc (36.0 KB, 280 views)
  

[AJPV]

TrevyRN - you're right. There are very few indications for hypertonic fluids. It is a standard of treatment for traumatic brain injury to try to keep intracranial pressure from spiking.

I was thinking blood transfusion BUT I kept wondering if there was another reason besides the blood loss for the low HGB - considering how lol HGB doesn't show up until later.

The view from the trauma room: It shows up pretty danged quickly... we draw serial crits at T=0, T=1 hr, and T=3 hr... and the bleeders become evident in pretty short order.

[akulahawkRN, ADN, RN, EMT-P]

TrevyRN - you're right. There are very few indications for hypertonic fluids. It is a standard of treatment for traumatic brain injury to try to keep intracranial pressure from spiking.

There are very few indications for hypertonic or hyperosmolar solutions in trauma. They do steal from total body water, and their effect is hard to gauge. You might see it used in certain types of trauma (military) as the people you'd use it on are young, usually well hydrated, and you can pack more bags of the stuff for the same weight of saline. Here's the problem... unlike saline, it's much harder to titrate these to a given blood pressure or MAP.

The downside of saline (or anything other than blood, really) is that while it can help restore circulating volume, it doesn't carry oxygen. If you're adding this stuff to a patient that's bleeding, you'll probably see the Crit fall pretty quickly. Even if you keep an actively bleeding patient as dry as you can, their body will be pulling from total body water as fast as it can, so you'll see the crit fall that way as well. However, early on in the blood loss, it's possible to have significant blood loss and a normal crit.