A hemodynamics question

[wonderbee]

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?

Thanks.

[wonderbee, BSN, RN]

Then, too, know that if you only pull the fluids off the tissues and into the vasular compartment, that will continue the cycle...will lead right back to too much fluid in the vasculature, force it back out into the tissues, as well as congest the lungs and heart.

Verrrrrrrrrrrrry tricky business... which mandates fine tuning.

Thoroughly confused now? :stone

Actually no, I'm not exactly confused but definitely fascinated. I see where tx is extremely complicated and treating one condition leads to another. I guess that at this point when the heart starts to poop out, one would push digoxin to keep the cardiac output going as long as possible, then monitor those fluids with strict I&O and be ready to switch or stop the drip real quick.

[jnette, ASN, EMT-I]

Actually no, I'm not exactly confused but definitely fascinated. I see where tx is extremely complicated and treating one condition leads to another. I guess that at this point when the heart starts to poop out, one would push digoxin to keep the cardiac output going as long as possible, then monitor those fluids with strict I&O and be ready to switch or stop the drip real quick.

You're on !!! A combination of all the above, (especially with CHF).

...in case of pulmonary edema you would also want to include 02 and possibly morphine IV in SMALL amounts to reduce venous return and redistribute the blood volume from the pulmonary circulation to other parts of the body. (this decreases pressure in the pulm. cappillaries and the resulting seepage of fluids into the lung tissue).

Of course the anxiety reducing effects of morphine is especailly beneficial in pulmonary edema as well ! Pulmonary edema is a frightening experience.

[malenurse1]

Okay..now my head is spinning! I think I'm getting it though, thanks everyone. Great question RNKittyKat!

[jnette, ASN, EMT-I]

ooooooooops !!!

And yes, Duckboy made some very valid points... it really depends on what's going on with your patient... what the etiology is there. Once that is understood, you would have a better guide to treating the symptoms.

Good job, Duckboy ! Thanx for coming to my rescue !

[duckboy20]

I did not come to your rescue, just helping :) You were doing a good job!

[malenurse1]

I guess it just goes to show you have to look at the whole assessment of all body systems before determining a course of treatment!

[jnette, ASN, EMT-I]

I guess it just goes to show you have to look at the whole assessment of all body systems before determining a course of treatment!

ALWAYS !!! You got it !

[malenurse1]

I hate it when my teachers are right, LOL.