solutions

solutions

• Intravenous fluid replacement may be necessary in conditions of gastrointestinal absorptive impairment or large fluid losses that cannot be quickly replaced via the enteral route. The specific type of fluid replacement therapy will be determined by the individual patient’s needs. Table 25.2 shows the compo - sition of some commonly used intravenous fluid replacement solutions, in contrast to the average composition of the same components in plasma. In addition to the crystalloid fluid solutions above, fluid can also be replaced with colloid solutions, which usually con - tain a form of modified gelatin. Examples of these include Gelofusine® or V olplex®, which both contain 4% w/v suc - cin ylated gelatin, or V oluven®, which contains hydroxy ethyl starch. These solutions are often used as plasma expanders as - the larger molecules are thought to be slower to di ff use into the extravascular space. Colloids are therefore sometimes used f or fluid resuscitation in preference to crystalloids, but they can cause renal failure or coagulopathy . There is ongoing contro - versy regarding the use of crystalloids or colloids in the setting of fluid resuscitation. Albumin solutions have also been used /H11022

(iii) Acute disease effect Add a score of 2 if there has been or is likely to be no or very little nutritional intake for 5 days 2 or more High Tr eat Hospital – refer to dietician or Care homes (as for hospital) Figure 25.2 The Malnutrition Community (as for hospital) Universal Screening Tool (MUST) for adults. (Adapted from Elia M (ed.). The MUST Report. Nutritional screening of adults: a multidisci

plinary responsibility. Development and use of the ‘Malnutrition Uni

versal Screening Tool’ (‘MUST’) for adults . A report by the Malnutrition Advisory Group of the British Association for Parenteral and Enteral Nutrition. Report no. 152. Redditch: BAPEN, 2003. ISBN 1 899467 70 X.)

in the past for fluid resuscitation; however, increasing evidence shows no benefit for the use of albumin outside of certain spe cific indications such as replacement of ascitic fluid losses or in the context of liver insu ffi ciency . It is important to remember that if fluid loss is related to haemorrhage then the best form of fluid replacement is b lood. It must be noted that, as seen in Table 25.2 , none of the di ff erent intravenous fluid replacement solutions have electro lyte levels that completely mirror plasma levels, and thus ther is no single ideal fluid replacement therapy . The specific choice of fluid replacement should take into account the nature of fluid losses and the amount of fluid replacement necessary in a specific patient. Such an assessment would include: /uni25CF measurement of the pulse, blood pressure and, if available, the central venous pressure, as an estimate of intravascular fluid depletion; /uni25CF accurate intake and output charts, especially in inpatients in the acute care setting, taking into account urine output as well as losses from drains, fistulae, nasogastric tubes and faecal losses; /uni25CF measurement of serum electrolytes and haematocrit. The choice of fluid replacement will also be guided by the time of gastrointestinal fluid loss, as the composition of gastrointestinal secretions varies with anatomical location ( Table 25.3 ).

commonly used intravenous /f_l uid replacements. Plasma 0.9% Hartmann’s 5% saline solution dextrose Sodium 135–145 154 131 0 (mmol/L) Chloride 95–105 154 111 0 (mmol/L) Potassium 3.5–5.3 0 5 0 (mmol/L) Bicarbonate 24–32 0 29 0 (mmol/L) Calcium 2.2–2.6 2 2 0 (mmol/L) Magnesium 0.8–1.2 0 0 0 (mmol/L) Glucose 3.5–5.5 0 0 227.8 (mmol/L) (50 /uni00A0 g) Lactate 0.5–1.0 0 29 0 (mmol/L) pH 7.35–7.45 4.5–7.0 5.0–7.0 3.5–5.5 Osmolality 275–295 308 273 278 (mOsmol/L) (mmol/L). Sodium Potassium Chloride Bicarbonate Saliva 10 25 10 30 Stomach 50 15 110 – Duodenum 140 5 100 – Ileum 140 5 100 30 Pancreas 140 5 75 115 Bile 140 5 100 35

solutions

• Intravenous fluid replacement may be necessary in conditions of gastrointestinal absorptive impairment or large fluid losses that cannot be quickly replaced via the enteral route. The specific type of fluid replacement therapy will be determined by the individual patient’s needs. Table 25.2 shows the compo - sition of some commonly used intravenous fluid replacement solutions, in contrast to the average composition of the same components in plasma. In addition to the crystalloid fluid solutions above, fluid can also be replaced with colloid solutions, which usually con - tain a form of modified gelatin. Examples of these include Gelofusine® or V olplex®, which both contain 4% w/v suc - cin ylated gelatin, or V oluven®, which contains hydroxy ethyl starch. These solutions are often used as plasma expanders as - the larger molecules are thought to be slower to di ff use into the extravascular space. Colloids are therefore sometimes used f or fluid resuscitation in preference to crystalloids, but they can cause renal failure or coagulopathy . There is ongoing contro - versy regarding the use of crystalloids or colloids in the setting of fluid resuscitation. Albumin solutions have also been used /H11022

(iii) Acute disease effect Add a score of 2 if there has been or is likely to be no or very little nutritional intake for 5 days 2 or more High Tr eat Hospital – refer to dietician or Care homes (as for hospital) Figure 25.2 The Malnutrition Community (as for hospital) Universal Screening Tool (MUST) for adults. (Adapted from Elia M (ed.). The MUST Report. Nutritional screening of adults: a multidisci

plinary responsibility. Development and use of the ‘Malnutrition Uni

versal Screening Tool’ (‘MUST’) for adults . A report by the Malnutrition Advisory Group of the British Association for Parenteral and Enteral Nutrition. Report no. 152. Redditch: BAPEN, 2003. ISBN 1 899467 70 X.)

in the past for fluid resuscitation; however, increasing evidence shows no benefit for the use of albumin outside of certain spe cific indications such as replacement of ascitic fluid losses or in the context of liver insu ffi ciency . It is important to remember that if fluid loss is related to haemorrhage then the best form of fluid replacement is b lood. It must be noted that, as seen in Table 25.2 , none of the di ff erent intravenous fluid replacement solutions have electro lyte levels that completely mirror plasma levels, and thus ther is no single ideal fluid replacement therapy . The specific choice of fluid replacement should take into account the nature of fluid losses and the amount of fluid replacement necessary in a specific patient. Such an assessment would include: /uni25CF measurement of the pulse, blood pressure and, if available, the central venous pressure, as an estimate of intravascular fluid depletion; /uni25CF accurate intake and output charts, especially in inpatients in the acute care setting, taking into account urine output as well as losses from drains, fistulae, nasogastric tubes and faecal losses; /uni25CF measurement of serum electrolytes and haematocrit. The choice of fluid replacement will also be guided by the time of gastrointestinal fluid loss, as the composition of gastrointestinal secretions varies with anatomical location ( Table 25.3 ).

commonly used intravenous /f_l uid replacements. Plasma 0.9% Hartmann’s 5% saline solution dextrose Sodium 135–145 154 131 0 (mmol/L) Chloride 95–105 154 111 0 (mmol/L) Potassium 3.5–5.3 0 5 0 (mmol/L) Bicarbonate 24–32 0 29 0 (mmol/L) Calcium 2.2–2.6 2 2 0 (mmol/L) Magnesium 0.8–1.2 0 0 0 (mmol/L) Glucose 3.5–5.5 0 0 227.8 (mmol/L) (50 /uni00A0 g) Lactate 0.5–1.0 0 29 0 (mmol/L) pH 7.35–7.45 4.5–7.0 5.0–7.0 3.5–5.5 Osmolality 275–295 308 273 278 (mOsmol/L) (mmol/L). Sodium Potassium Chloride Bicarbonate Saliva 10 25 10 30 Stomach 50 15 110 – Duodenum 140 5 100 – Ileum 140 5 100 30 Pancreas 140 5 75 115 Bile 140 5 100 35

solutions

• Intravenous fluid replacement may be necessary in conditions of gastrointestinal absorptive impairment or large fluid losses that cannot be quickly replaced via the enteral route. The specific type of fluid replacement therapy will be determined by the individual patient’s needs. Table 25.2 shows the compo - sition of some commonly used intravenous fluid replacement solutions, in contrast to the average composition of the same components in plasma. In addition to the crystalloid fluid solutions above, fluid can also be replaced with colloid solutions, which usually con - tain a form of modified gelatin. Examples of these include Gelofusine® or V olplex®, which both contain 4% w/v suc - cin ylated gelatin, or V oluven®, which contains hydroxy ethyl starch. These solutions are often used as plasma expanders as - the larger molecules are thought to be slower to di ff use into the extravascular space. Colloids are therefore sometimes used f or fluid resuscitation in preference to crystalloids, but they can cause renal failure or coagulopathy . There is ongoing contro - versy regarding the use of crystalloids or colloids in the setting of fluid resuscitation. Albumin solutions have also been used /H11022

(iii) Acute disease effect Add a score of 2 if there has been or is likely to be no or very little nutritional intake for 5 days 2 or more High Tr eat Hospital – refer to dietician or Care homes (as for hospital) Figure 25.2 The Malnutrition Community (as for hospital) Universal Screening Tool (MUST) for adults. (Adapted from Elia M (ed.). The MUST Report. Nutritional screening of adults: a multidisci

plinary responsibility. Development and use of the ‘Malnutrition Uni

versal Screening Tool’ (‘MUST’) for adults . A report by the Malnutrition Advisory Group of the British Association for Parenteral and Enteral Nutrition. Report no. 152. Redditch: BAPEN, 2003. ISBN 1 899467 70 X.)

in the past for fluid resuscitation; however, increasing evidence shows no benefit for the use of albumin outside of certain spe cific indications such as replacement of ascitic fluid losses or in the context of liver insu ffi ciency . It is important to remember that if fluid loss is related to haemorrhage then the best form of fluid replacement is b lood. It must be noted that, as seen in Table 25.2 , none of the di ff erent intravenous fluid replacement solutions have electro lyte levels that completely mirror plasma levels, and thus ther is no single ideal fluid replacement therapy . The specific choice of fluid replacement should take into account the nature of fluid losses and the amount of fluid replacement necessary in a specific patient. Such an assessment would include: /uni25CF measurement of the pulse, blood pressure and, if available, the central venous pressure, as an estimate of intravascular fluid depletion; /uni25CF accurate intake and output charts, especially in inpatients in the acute care setting, taking into account urine output as well as losses from drains, fistulae, nasogastric tubes and faecal losses; /uni25CF measurement of serum electrolytes and haematocrit. The choice of fluid replacement will also be guided by the time of gastrointestinal fluid loss, as the composition of gastrointestinal secretions varies with anatomical location ( Table 25.3 ).

commonly used intravenous /f_l uid replacements. Plasma 0.9% Hartmann’s 5% saline solution dextrose Sodium 135–145 154 131 0 (mmol/L) Chloride 95–105 154 111 0 (mmol/L) Potassium 3.5–5.3 0 5 0 (mmol/L) Bicarbonate 24–32 0 29 0 (mmol/L) Calcium 2.2–2.6 2 2 0 (mmol/L) Magnesium 0.8–1.2 0 0 0 (mmol/L) Glucose 3.5–5.5 0 0 227.8 (mmol/L) (50 /uni00A0 g) Lactate 0.5–1.0 0 29 0 (mmol/L) pH 7.35–7.45 4.5–7.0 5.0–7.0 3.5–5.5 Osmolality 275–295 308 273 278 (mOsmol/L) (mmol/L). Sodium Potassium Chloride Bicarbonate Saliva 10 25 10 30 Stomach 50 15 110 – Duodenum 140 5 100 – Ileum 140 5 100 30 Pancreas 140 5 75 115 Bile 140 5 100 35