اشتباهات شایع در بخش آی سی یو 10
Do not Bolus Fluids that Contain Dextrose
Awori J. Hayanga MD
Intravenous fluids that contain dextrose have questionable utility in the intensive care unit (ICU) and should not be administered at a rate greater than maintenance fluids. Bolusing with dextrose-containing fluids causes a rapid change in extracellular osmolarity. This can occur quite rapidly and may cause convulsions and coma. At the very least, bolusing with dextrose will cause an unacceptably high serum glucose, which is detrimental in intensive care patients.
Acceptable fluids to bolus with include normal saline, hypertonic saline, and Lactated Ringer's. Lactated Ringer's is an excellent isotonic salt solution for replacing isotonic gastrointestinal losses and pre-existing volume deficits when a patient has a normal or near normal electrolyte level. Isotonic sodium (0.9% saline) is ideal for the initial correction of depleted extracellular fluid volume associated with hyponatremia, hypochloremia, and metabolic alkalosis. One concern with normal saline is that the high chloride concentration may exceed the capacity of the kidney to excrete it and has the potential to cause dilutional acidosis.
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