NCBI Bookshelf. Shashank Singh ; Connor C. Kerndt ; David Davis. Authors Shashank Singh 1 ; Connor C.
Kerndt 2 ; David Davis 3. Often confused with lactic acid, lactate is the compensatory base of lactic acid.
Under aerobic physiologic conditions, the metabolism of glucose le to the production of pyruvate into cellular respiration. If this aerobic system shuts down, the protons have nowhere to go. Volume kinetics is a complex topic but can be simplified with the following fluid characteristics, osmolarity, and tonicity. Osmolarity among all fluid compartments at any given time will remain equal, or actively equalizing, oranve water free flows between all compartments.
Tonicity is a measure of the osmotic water gradient between 2 fluids across a semipermeable membrane and is a relative concept between these 2 fluids. When describing a fluid in terms of tonicity, in other words, hypotonic, isotonic, or hypertonic, the tonicity refers to the osmotic gradient between the intracellular and extracellular compartments. The goal of administration is to replenish the intravascular volume to permit adequate organ perfusion.
Logically, if giving a patient who is hyperkalemic additional potassium would worsen hyperkalemia; however, this is not correct. A patient's potassium volume of distribution odange larger than the extracellular compartment and equilibrates between the intracellular and extracellular compartments.
As with any IV fluid administration, there is a possibility of swelling and edema. These patients must be monitored during IV administration with serial physical exams to determine if they are becoming clinically hypervolemic. IV infiltration is also a possibility, which can cause localized swelling, redness and pain and leadong is treated with conservative management and replacement of the IV access.
Infection therapy can include local to systemic antibiotic therapy depending on the severity. The goal of therapy is to draw out free water from brain parenchyma using hypertonic fluid administration.
Although studies have compared the 2, a single study compared conventional fluid resuscitation versus hypertonic saline in hypotensive patients with traumatic brain injury in the prehospital setting. Patients on any intravenous fluid replacement need to be monitored for fluid overload.
As stated above, any crystalloid fluid distributes across the extracellular fluid compartment equally in an approximately ratio interstitial: intravascular under normal physiologic conditions. Patients at high risk for fluid overload are those with congestive heart failure, renal disease, and liver cirrhosis.
In these cases, IV fluid administration should be done cautiously. Monitoring of the site of infusion and IV access is necessary to make sure that the fluid is, in fact, being delivered into the vein.
IV sites should be monitored for any s of infiltration, redness, pain, swelling or discomfort. If present, the infusion should be stopped, and other IV access should be established.
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