Crystalloid solution: description, use and indications
The crystalloid solution has specific properties. It is actively used in surgery and therapeutic purposes. Due to its active composition, it quickly penetrates into tissues, blood, regulating acid-base and water-electrolyte metabolism.
What is it?
Colloidal and crystalloid solutions are also called blood substitutes, as they replace or normalize lost blood functions. They must meet certain requirements:
- safety( not to be toxic);
- functionality( have medicinal properties);
- stability( should not enhance its effect upon repeated administration).
Blood substitutes are divided into two groups: solutions of colloidal and crystalloid. The first include "Lactosol", "Disol", "Acesol", to the second - "Polyglukin", "Reogluman", "Volekam", "Infuzol" and others.
The crystalloid solution is used to replenish the volume of circulating blood if the rate of bleeding is small and blood loss is less than fifteen percent. In this case, Ringer's solution is used. Crystalloids are used as drug solvents. The most common 5% glucose, "Sterofundin", that is, weakly hypertensive and isotonic solutions. Crystalloids are needed to fill the lack of electrolytes and energy, as a hemostatic.
Colloids are designed to change the osmotic pressure in a blood vessel. This stabilizes the volume of circulating blood and hemodynamics. They normalize blood pressure and keep it in norm. The colloids include "Venozol", "Gelofusin", "Refortan", "Stabisol", "Volyuven", "Perftoran".Sometimes, in conditions of delayed blood flow, crystalloid solutions are used together with colloidal solutions. They reduce blood viscosity, restore blood circulation, improve hemodynamics, nourish tissues and organs, restore hemoglobin and keep it in norm.
Infusion substances have a working classification. They are divided into preparations of blood components, crystalloid solutions and colloids. At the heart of the separation lies the belonging to inorganic and organic substances and properties. All solutions must necessarily be fluid, safe for health, non-toxic, easily dosed, neutral for different drugs, stable. Their base is NaCl. Crystalloids include Ringer-Lok solutions, electrolytes( hypertonic and hypotonic).Blood substitutes are divided according to the mechanism of therapeutic action:
- Blood substitutes that carry oxygen.
- Infusion antihypoxants.
- Blood substitutes for complex action.
To colloids include natural replacement solutions( plasma, albumin) and synthetic, to crystalloid( salt) blood substitutes - hypotonic, hypertonic and isotonic solutions. Colloids fill the volume of extracellular fluid, support it during surgery, treat moderate hypovolemia.
Despite good tolerability of crystalloids by the human body, they have contraindications depending on the composition. Isotonic sodium chloride solution is saline, it contains nine grams of the main substance. In relation to the blood plasma, it is hypertonic, the reaction is weakly acidic. If you enter a large amount of sodium chloride, then you can provoke metabolic acidosis. Ringer's solution with lactate has a physiological composition. The drug is combined, has a wide scope of application, especially in case of traumas of incomprehensible etiology. The ions K + in the solution can adversely affect the adrenal glands and kidneys if the patient has dysfunction of these organs.
"Normasol" solution, in comparison with the previous one, has more pronounced therapeutic properties. The drug is known for its vasodilating action, but it can interfere with the occurrence of vasoconstriction, which maintains blood pressure in normal conditions against hypovolemia. In addition, Ringer's solution is incompatible with and in part with drugs such as Ampicillin, Vibramycin, Minocycline, Amicacin, Ornid, Anaprilin, Urokinase, and others. For intravenous administration,glucose solution. It maintains the level of carbohydrates, ensures the normal functioning of the central nervous system in patients with disorders of the nervous system. However, glucose infusions can provoke the appearance of lactic acid in the organs affected by ischemic disease. First of all, it concerns the central nervous system.
How to use
Crystalloid solutions for infusion therapy and recovery of extracellular fluid loss are suitable. Most often they are used for large blood loss. For example, with hemorrhagic shock, the solution is injected in a volume of 3 ml per each milliliter of blood loss in a ratio of 3: 1.Adult patients are injected with a jet of one liter each. The amount of the solution is adjusted taking into account the age, as well as the presence of cardiovascular diseases. In order to avoid an overdose, invasive monitoring is mandatory.
To children, the solution is injected in a dose of 20 ml / kg. After the administration of each dose of the drug, the condition of the child is assessed. If after three doses the parameters of hemodynamics are unstable, the doctor urgently begins blood transfusion. If a patient is suspected of internal bleeding, the patient is referred to the operating room.
Crystalloid solution belongs to the group of blood substitutes. This includes infusion substances of sugars and electrolytes. Thanks to them, the body restores water, electrolyte and acid balances. Solutions from this group quickly from the vessels go into cells depending on the composition. They are conventionally divided into several groups:
- replacing( if a person lost a lot of blood and requires compensation for electrolytes and water);
- basic( provide equilibrium);
- corrective( restore the imbalance of ions and water).
Crystalloids provide the transition of liquid to the extracellular space, are quickly excreted by the kidneys, have a limited effect and its duration, can provoke hypoxia, swelling of the lungs and internal organs. Caution should be used for patients with heart and kidney disease.
Side effects of
Crystalloid solutions prior to intravenous administration must be checked for compliance. Usually, they are easily tolerated by patients, do not affect immunity, internal organs( if there are no concomitant diseases), maintain electrolyte balance, but are capable of causing hypertonic edema due to rapid redistribution from vessels to cells and the need for high doses. Colloids are often used in medical practice.
The most common are albumin solution 25% and 5%, getastarcha 6% and dextran-40.If you enter intravenously a large amount of colloids, you can provoke the development of dilutional coagulopathy and infection with the hepatitis virus( in rare cases).Side effects are sometimes allergic reactions. The solution of the heterostarch can increase the level of amylase in the blood several times. This condition persists for five days, but does not lead to pancreatitis. It is important during the treatment to monitor the patient's condition.
Large volume of solution does not provoke problems of blood coagulability. A solution of dextrans causes bleeding, reduces platelet aggregation, and promotes fibrinolysis. Sometimes anaphylactic reaction is observed in patients. The drug for the period of use can make it impossible to determine the blood group, to provoke renal failure. Names of crystalloid solutions were obtained by their properties and composition, into which the active substance enters.
Colloidal and crystalloid solutions in medicine are used frequently. Their cost depends on the name of the means, the manufacturer, the volume. For example, a bottle of solution "Reopoliglyukin" 10%, 400 ml is 119 rubles. Colloid solutions for the patient are expensive, and the positive effects are not always justified.