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Doctors Medicines MCQs Q&A

A patient presents to the emergency department with a complaint of watery diarrhea for the past three days. Assessment findings include blood pressure - 100/60, pulse - 98, and dry mucous membranes. The healthcare provider would anticipate intravenous therapy administration with which of the following fluids?

A patient presents to the emergency department with a complaint of watery diarrhea for the past three days. Assessment findings include blood pressure - 100/60, pulse - 98, and dry mucous membranes. The healthcare provider would anticipate intravenous therapy administration with which of the following fluids? Correct Answer Isotonic crystalloid

Concept:

  • Intravenous fluid therapy is described as infusions of crystalloids, colloids, or a combination of both. Indication for IV therapy is volume resuscitation e.g. severe diarrhea or hemorrhage; a vehicle for administering IV drugs.

 Important Points

  • Crystalloids are clear fluids made of water and electrolyte solutions and can cross the semi-permeable membrane. For instance, Normal saline, Dextrose solution, and Ringer lactate solution.

Solutions are classified as:

  • Isotonic crystalloid
  • Hypotonic crystalloid
  • Hypertonic crystalloid

Key Points 

Isotonic crystalloid

  • 'Iso' means equal and 'tonic' means concentration of a solution. An isotonic solution is one in which the concentration of solute is the same both inside and outside of the cell. For instance, 0.9% normal saline and 5% dextrose and Lactated Ringer's are isotonic fluids (Hence option 1 is correct).
  • To increase extracellular fluid volume due to blood loss, surgery, dehydration, and fluid loss (Hence option 1 is correct).

Hypotonic crystalloid

  • Hypo means 'under' and tonic means 'concentration of a solution. A hypotonic solution is one in which the concentration of solutes is greater inside the cell than outside of it.
  • As a result of the administration of the hypotonic solution, the water is transported into the cell.
  • For instance 0.45% Normal saline; 0.225% of normal saline.
  • Indication: Diabetic Ketoacidosis or Hyperosmolar Hypoglycemia.

Hypertonic crystalloid

  • Hyper means 'excessive' and tonic means concentration of the solution. A hypertonic solution is one where the concentration of solutes is greater outside of the cell inside it.
  • Result: water is transported out from the cell.
  • For instace 3% saline and 5% dextorse in 0.9% saline and 5% Dextrose in 0.45% of saline.
  • Indications: Severe Hyponatremia and cerebral edema


Additional Information

  • Colloid solution: The word colloid comes from the Greek word 'Kolla' which means glue thus colloidal particles are glue-like substances that are microscopically dispersed throughout another substance.  Additionally, since the colloids are large molecular substances hence these largely remain in the intravascular compartment. Indications are plasma volume expansion; hypo-proteinuria and therapeutic plasmapheresis. However, these are contraindicated in severe anaemia, cardiac failure and hypersensitive reaction.

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