Colloids And Crystalooids

Prepared by: Sondos Shalabi Supervised by: Dr. Osama Attallah

Intravenous therapy
the infusion of liquid substances directly into a vein. Substances that may be infused:
volume
 

expanders

Crystalloids colloids

blood-based

products blood substitutes Buffer solutions Medications nutrition.

Volume expander
a type of IV therapy that has the function of:
1. 2.

providing volume may be used for fluid replacement.

Two main types:

Crystalloids : aqueous solutions of mineral salts or other water-soluble molecules. Colloids: IV fluids that contain solutes in the form of large proteins or other similarly sized molecules.

Colloids
Dont pass through diffusional membranes. Stay,,preserve a high colloid osmotic pressure in the blood. Attract water from cells. preferentially increase the intravascular volume.


crystalloids also increase the interstitial volume and intracellular volume.

Eg:5% albumin, gives plasma expansion nearly twice that produced by an equivalent volume of isotonic saline This the benefit: more effective volume resuscitation.

Colloid osmotic pressure

Oncotic pressure. Osmotic pressure or hydrostatic. the ability of each fluid to expand the plasma volume is directly related to the COP COP of plasma=25mmHg If > ,, plasma volume expansion exceeds the infused volume
Transient volume expansion May worsen edema in severe hemorrhagic shock

Expensive have specific storage requirements have a short shelf life

Types:
Albumin dextrans Hetastarch gelatins

Albumin
A transport protein that is responsible for 75% of COP. Heat sterilized pooled human plasma. 5% solution (50 g/L) 25% solution(250 g/L), the salt poor albumin

Features
A 5% albumin COP 20 mm Hg

similar in oncotic activity to plasma isotonic Approximately half of the infused volume stays in the vascular space. The oncotic effects of albumin last 12 to 18 hours.

25% albumin COP of 70 mm Hg

Hypertonic expands the plasma volume by 4 to 5 times the volume infused

This plasma volume expansion occurs at the expense of the interstitial fluid volume so 25% albumin should not be used for volume resuscitation in hypovolemia.


shifting fluid from the interstitial space to the vascular space

Disadvantages
Allergic reactions-rare Cogulopathies- dilutional Induce renal failure Impair pulmonary function

In hemorrhagic shock

The Dextrans
glucose polymers produced by a bacterium incubated in a sucrose medium First introduced in the 1940s these colloids are not popular because of the perceived risk of adverse reactions.
10%

dextran-40 6% dextran-70 both diluted in isotonic saline.

Features
hyperoncotic to plasma (COP = 40 mm Hg). Dextran-40 causes a larger increase in plasma volume than dextran-70


but the effects last only a few hours.

Dextran-70 is the preferred preparation



because of its prolonged action.

Initial volume expansion Reduce blood viscosity

Disadvantages
a dose-related bleeding tendency
inhibiting platelet aggregation  reducing activation of Factor VIII  promoting fibrinolysis.


Anaphylactic reactions -5% of patients coat the surface of red blood cells
interfere


with the ability to cross-match blood the erythrocyte sedimentation rate

Must wash it

increase

acute renal failure



hyperoncotic state with reduced filtration pressure

Hydroxyethyl starch
produced by the hydrolysis of insoluble amylopectin. substitutions of hydroxyl groups for carbon groups on glucose molecules. Molecular weight from 1000-3,000,000 Hexa-starch Penta-starch Hextend

Hexastarch
6% solution in isotonic saline. Molecular weight similar to albumin. colloid effects are equivalent to those of 5% albumin. cheaper than albumin

Disadvantages
Coagulopathies
decreases

in von Willebrand's factor and factor VIII:c postoperative bleeding in cardiac and neurosurgery patients.

can induce renal dysfunction hyperchloremic acidosis -high chloride content cleaved by serum amylase enzymes
Hyperamylasemia


not pancreatitis

Check lipase

Anaphylactic reactions

Hextend
modified, balanced, high molecular weight suspended in a lactate-buffered solution No Coagulopathies. hemodilution

Gelatins
produced from bovine collagen. urea-linked gelatin succinylated gelatin

(modified fluid gelatin, Gelofusine). coagulopathies

Crystalloids

Crystalloids
The primary fluid used for prehospital IV therapy contain electrolytes (e.g., Na, K, Ca, Cl) Pass readily through membranes. principal component is NaCl. NaCl predominant solute in ECF
 Plasma  Interstitium 75-80%


predominant effect of volume resuscitation with crystalloid fluids is to expand the interstitial volume rather than the plasma volume.

Eg:
infusion of 1 L of 0.9% sodium chloride (isotonic saline) adds 275 mL to the plasma volume and 825 mL to the interstitial volume. =1100 mL is slightly greater than the infused volume fluid shift from the intracellular to extracellular space.


isotonic saline is actually hypertonic to ECF

classified according to their tonicity.

Isotonic Hypertonic Hypotonic

low blood volume

cellular dehydration

Isotonic saline
Prototype 0.9% sodium chloride (NaCl) in sterile water 9 g NaCl per liter. pH slightly lower than plasma


No clinical significance Risk of hyperchloremic metabolic acidosis

Cl content higher than plasma



To correct volume deficits associated with hyponatremia, hypochloremia and metabolic alkalosis.

pH=4.5 - 7

Lactated Ringers
isotonic crystalloid contains
sodium chloride  potassium chloride  calcium chloride  sodium lactate
 

in sterile water.

Hartmanns solution

lactate (28 mEq/L) Less Na, Cl than normal saline No proven buffering action of lactate No proven benefit over normal saline

Disadvantages
activates the inflammatory respons induces apoptosis.


D isomer of lactate

The Ca can bind to certain drugs and reduce their bioavailability and efficacy. Also bind to citrated anticoagulant in blood products.
 

formation of clots in donor blood. lactated Ringers solution is contraindicated as a diluent for blood transfusions.

5% Dextrose in water
(D5W) is packaged isotonic carbohydrate solution Glucose is the solute. not an effective volume expander intended to supply calories obsolete 50 g dextrose per liter provides 170 kcal per liter Osmolality 253 mOsml

Disadvantages
once D5W enters the body, the cells rapidly consume glucose.
This leaves primarily water  IV fluid hypotonic in relation to the plasma  an osmotic shift of water into the cells.


addition of dextrose to intravenous fluids increases osmolarity



creates a hypertonic infusion osmotic force cell dehydration.

If glucose use is impaired (critically ill patients)



enhanced lactate production (critically ill patients)

Normosol
Contents of Normosol:
Na = 140 mEq/L Cl = 98 mEq/L K = 4 mEq/L Mg = 3 mEq/L Acetate = 27 mEq/LGluconate = 23 mEq/L PH =6.6

added buffer capacity pH that is equivalent to that of plasma addition of magnesium



magnesium depletion in hospitalized patients.

When to use which??

fluid selection depends on:
the estimated fluid loss the primary fluid compartment involved the patient's underlying problem the physiological and hemodynamic impact of the IV solution.

When to use which?? Crystalloids

the early popularity of crystalloid fluid resuscitation in hypovolemia stems from two observations: the response to mild hemorrhage,


which involves a shift of fluid from the interstitial space to the vascular space.

from studies in an animal model of hemorrhagic shock

survival improved if a crystalloid fluid was given along with reinfusion of the shed blood volume. hemorrhage is an interstitial fluid deficit mild hemorrhage

replacement of interstitial fluid with crystalloid fluids is important for survival.

When to use which?? Colloids

If blood loss is more severe the priority is to keep the vascular space filled and thereby support the cardiac output. colloid fluids are more effective
colloid

fluids are about three times more potent than crystalloid fluids for increasing vascular volume and supporting the cardiac output

Crystalloid resuscitation can achieve the same endpoint

larger

volumes are needed 3 times

Survival in hemorrhagic shock

Colloids no higher rate despite superiority in volume expansion Some studies- increased mortality

Expense

Colloids higher expense

Edema

crystalloid -expected feature

 

fluids distribute primarily in the interstitial space

Colloid- risk
If permeability is disrupted  Eventually albumin finds its way to interstitium some how

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