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Fluids Of Choice!

Author: drashmiyadav, Posted on Wednesday, July 07 @ 10:49:39 IST by RxPG  

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Surgery

Q.In a patient, who has become dehydrated, body water should be replaced by
intravenous infusion of:


a) distilled water
b) 0.9% sodium chloride solution
c) 5% glucose solution
d) 10% glucose solution

reference: lee 12th edition/pg 22,ganong 18th edition pg 682,Nelson 16th edition

quality: thinker

discussion:

Fluid therapy consists of three categories:
1) maintenance,
2) deficit replacement, and
3) supplemental replacement of ongoing losses.

Maintenance fluid expenditures are a function of metabolic rate, and maintenance therapy is designed to replace usual body losses of fluid and electrolytes.

Deficit is described as losses per kg of body weight,
and deficit therapy is designed to replace abnormal losses of fluid and electrolytes, usually as a result of an illness.

Supplemental replacement is based on measured or estimated continuing abnormal losses; supplemental therapy, when indicated, is given in addition to maintenance and deficit fluids

When the choice of fluid comes, it depends on the requirement of the patient,
like,
A fasting preoperatively stable youngster awaiting surgery may need only maintenance fluid and electrolytes before restoration of oral intake postoperatively,

but a child with diarrheal dehydration probably needs all components: maintenance, deficit, and supplemental therapy.

The question specifically asks for replacement of body water in a person who is dehydrated.


explanation:

a) distilled water: cant be used as is hypotonic, and will cause further metabolic complications due to over dilution.
b) 0.9% sodium chloride solution: lee says, it is the 1st used fluid in shock; injudicial use has always leaded to Na+ overload.
c) 5% glucose solution: this is an ideal fluid to be used to replace the lost water from the body, in dehydration. This also, usually provides enough calories to have some sparing effect on catabolism of protein.
d) 10% glucose solution: this is a hyper tonic solution and would further lead to shrinkage of ECF volume. This is generally used in immediate treatment of hypoglycemia.

correct choice:(c) (5% glucose)

remember:

1)Fluid Of choice in hypovolemic shock: normal saline,ringer lactate.
2)Fluid of choice in shock due to blood loss : whole blood transfusion.
3)Fluid of choice in a dehydrated individual:5% glucose.
4)Fluid of choice in a patient with hypertrophic pyloric stenosis/repeated vomiting:normal saline/with or without supplemental potassium depending on the patient requirement.
5)Fluid of choice in hypoglycemia: 10-25% glucose.

Explanation by Dr Rashmi Yadav, Author of




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