BODY FLUID COMPARTMENTS

• TBW: 60% of body weight (42L)

• ICF:
- 40% of body weight (28L)
- 2/3rd of TBW

• ECF: 20% of body weight (14L)

- Interstitial fluid (15% of body
weight, 11L)
- Blood plasma (5% of body weight,
3L)
- 75 to 80% ECF is in interstitial fluid
Blood is a fluid connective tissue that circulate
continuously around the body

Plasma is a clear, straw coloured, watery fluid in

which several different types of blood cells are
suspended

Serum is plasma without clotting factors

Volume Expanders
 Volume expanders are the intravenous
fluid solutions that are used to
increase or retain the volume of fluid
in the circulating blood.
 Generally volume expanders are used
to replace fluids that are lost due to
illness, trauma or surgery.
They do not carry oxygen .
Types of volume expanders
There are two main types of volume expanders:
1. Crystalloids: crystalloids are aqueous
solutions of mineral salts or other water-
soluble molecules. E.g. normal saline,
dextrose, Ringer’s solution etc.
2. Colloids: Colloids are larger insoluble molecules,
such as dextran, human albumin, gelatin, blood.
Blood itself is a colloid.
 Colloids are better than
Crystalloids because:
 The larger molecules of colloids are
retained more easily in the intravascular
space & increase osmotic pressure.
 So, more effective resuscitation of plasma
volume occurs by colloids than produced
by that of crystalloids.
 Duration of action is relatively longer
than crystalloids.
Ideal properties of PVEs.
 Iso-oncotic with plasma
 Distributed to intravascular
compartment only
 Pharmacodynamically inert
 Non-pyrogenic, non-allergenic & non-
antigenic
 No interference with blood grouping
 Stable, easily sterilizable and cheap
Colloidal Plasma expanders -

 Human albumin
 Dextran
 Degraded gelatin polymer
(Polygeline)
 Hydroxyethyl starch
(Hetastarch/HES)
 Polyvinyl pyrrolidone (PVP)
Mechanism of action:
 Generally works on the principle of
osmosis.
 Increases Plasma osmotic pressure,
drawing water into plasma from interstitial
fluid.
 Since the lost blood is replaced with a
suitable fluid, the now diluted blood flows
more easily, even in small vessels. As a
result of chemical changes, more oxygen is
released to the tissues.
 1.Human Albumin
 It is obtained from human plasma.
 It can be used without regard to patient’s
blood group and doesn’t interfere with
coagulation.
 It is free of risk of transmission of
hepatitis because the preparation
is heat treated.
i
-First line s
Contd
…
 It has been used in acute
hypoproteinaemia, acute liver
failure and dialysis.
 It is comparatively expensive.
 Available products:
 Albudac, Albupan 50, 100 ml inj.,
 Albumed 5%, 20% infusion (100 ml)
Dextrans
 Are groups of branched polysaccharides derived from
sucrose by the action of the bacterium Leuconostoc
mesenteroides.
 Different dextran preparations are grouped on the basis
of their average molecular weight,
 Dextran 40, available as a 10% solution
 Dextran 60 and 70, prepared as a 6% solution
a) Dextran 70
1. It is most commonly used
preparation.
2. It expands plasma volume for nearly
24 hrs.
3. Excreted slowly by glomerular
filtration as well as oxidized in body
over weeks .
4. Some amount is
deposited in retuculo-
endothelial cells.
Dextran 70 has nearly all the properties of an
ideal plasma except:

 It may interfere with blood grouping and

cross matching.
 It can interfere with coagulation and
platelet function and thus prolong
bleeding time .
 Some polysaccharide reacting antibodies, if
present, may trigger anaphylactic reaction
like itching, bronchospasm, fall in BP.
b) Dextran 40

It acts more rapidly than dextran-70.
It reduces blood viscosity .

It is excreted through renal tubules and occasionally may

produce acute renal failure.
The total dose should not exceed 20 ml/kg in 24 hr.
Dextrans can be stored for 10 years and are cheap so are
the most commonly used plasma expanders.
Caution: Dextran doesn’t provide necessary electrolytes and
can cause hyponatremia or other electrolyte disturbances.
3. Degraded gelatin polymer
(polygeline)
It is synthetic polymer (polypeptide) of
MW-30,000.
 It doesn’t interfere with blood
grouping and cross matching and
is non-antigenic.
 Expands plasma volume for 12 hrs.
 It is more expensive than dextran.
Gelatin
 Gelatins are manufactured from bovine gelatin, a
derivative of collagen, which is cross-linked, urea linked,
or succinylated to yield the final products.

 The molecular weight ranges from 30 kDa to 35 kDa

 4. Hydroxyethyl
starch(Hetastarch)
  It is a complex mixture of ethoxylated amylopectin
of various molecular sizes
  It maintains blood volumelonger.
  It doesn’t cause acute renal failure or
coagulation disturbances.
  It improves hemodynamic status for 24 hrs.
Hetastarch contd..

 Adverse effects:
Vomiting, mild fever, itching, chills, flu
like symptoms, swelling of salivary
glands, bronchospasm etc.
 Brand:
Expan 6% inj (100 , 500 ml vac)
5. Polyvinylpyrrolidine(PVP)
 It is a synthetic polymer of average MW
40,000 used as a 3.5% solution.
 PVP was used as blood plasma
expander for trauma victims after
the 1950s.
 It interferes with blood grouping and cross
matching and is histmine releaser.
 It binds to penicillin and Insulin.
Contd
…I.tis excreted by kidney and small
amounts by liver into
bile.
 A fraction is stored in RE cells f or
prolonged periods.
 It is less commonly used plasma
expander.

Sample of PVP
 Other uses of PVP:
 PVP is also used in personal care
products such as shampoos and
toothpaste, hair sprays and gels.
 It is used as binder in many
pharmaceutical tablets.
 PVP added to Iodine forms a complex
called Povidone- Iodine that posses
disinfectant properties. And known
under the trade name of Betadine and
Pyodine.
CRYSTALLOIDS
• Crystal + oid (resembling a crystal)
• Electrolyte solutions with small molecules that can diffuse
freely throughout the extracellular space
• Relatively low tendency to stay intravascular
• Principal component is inorganic salt sodium chloride (NaCl)
• 75-80% of infused crystalloid is distributed in interstitial space
• Volume resuscitation with crystalloid fluids expand
interstitial volume rather than plasma volume
• Eg: Isotonic saline, Lactated Ringer’s solution, etc.,
TYPES OFCRYSTALLOIDS
1. Isotonic crystalloids:
When the concentration of the particles (solutes) is similar to thatof
plasma, it doesn't move into cells and remains within theextracellular
compartment thus increasing intravascularvolume.
Eg: 0.9% NaCl, Ringer’s lactate, D5W
2. Hypotonic solutions:
Compared with intracellular fluid (as well as compared with isotonic
solutions), hypotonic solutions have a lower concentration ofsolutes
(electrolytes). These solutions will hydrate cells, although their use
may deplete fluid within the circulatorysystem.
Eg: 0.45% sodium chloride (0.45% NaCl), 0.33% sodium chloride,0.2%
sodium chloride, and 2.5% dextrose in water
3. Hypertonic solutions:
Solution that have a higher tonicity or solute concentration. The
osmotic pressure gradient draws water out of the intracellularspace,
increasing extracellular fluid volume, so they are used as volume
expanders. Eg: 3% NaCl, D5NS
 WHEN TO BE GIVEN?
1) To treat low extracellular fluid as in fluid volume deficit from hemorrhage,
Severe vomiting or diarrhea, Heavy drainage from GI suction
2) Shock
3) Mild hyponatremia
4) It’s the fluid of choice for resuscitation efforts.