why preferable treatment in an emergency department is ort over intravenous replacement of fluid

ORT consists of a solution of salts and sugars which is taken by mouth. For most mild to moderate dehydration in children, the preferable treatment in an emergency department is ORT over intravenous replacement of fluid.

Full Answer

How are intravenous fluids treated in the emergency department?

Nearly one-quarter of emergency department (ED) patients in the United States are treated with intravenous (IV) fluids.1These fluids are typically stored at room temperature and infused into patients without prior warming.

Should fluid therapy be used in medically ill patients?

In this paper, we will discuss the best evidence and controversies for fluid therapy in medically ill patients. Intravenous fluid therapy is one of the most common therapeutic interventions performed in the ED, and is a long-established treatment.

Does prehospital fluid replacement improve outcomes in trauma patients?

Most studies concluded that hypotensive trauma patients did not have improved outcomes with prehospital fluid administration. In pediatrics, uncontrolled, large volume prehospital fluid replacement in pediatric patient leads to worse clinical outcomes.

What is IV fluid used for?

IV fluid is a drug Intravenous fluid administration is the second most common medical intervention next to supplemental oxygen. 1 Over 200 million liters of normal saline (NS) is used in the United States annually. 2 Intravenous fluids, like any other drug, should be given with thought and knowledge about the effects and sequelae to your patient.

Why is oral rehydration preferred over IV?

Switch from intravenous hydration to oral rehydration solution once hydration is improved and the patient can drink. This will conserve IV fluids and reduce the risk of phlebitis and other complications.

When is intravenous hydration preferred?

In severe dehydration, intravenous fluid replacement is preferred, and may be lifesaving. It is especially useful where there is depletion of fluid both in the intracellular space and the vascular spaces.

What's the purpose of replacement fluid therapy?

Fluids. Fluid replacement aims to restore circulatory volume (and thereby increase the rate of ketone clearance) and correct electrolyte imbalances.

What is the best guide to the adequacy of fluid resuscitation in a major trauma patient?

In severe and uncontrolled hemorrhagic shock, controlled resuscitation (MAP of 40 mmHg) is preferred [58]. International guidelines recommend SBP of 80–90 mmHg in trauma without brain injury and MAP ≥ 80 mmHg in TBI until major bleeding is controlled [2].

Is oral hydration better than IV hydration?

Furthermore, several studies have shown improvements in cardiovascular function and thermoregulation with IV fluid, while others have indicated that oral fluid is superior. Subsequent exercise performance has not been improved to a greater extent with one technique over the other.

What are the advantages of oral rehydration therapy?

The results indicate that oral rehydration treatment, used according to this protocol, is successful in treating severe diarrhoea and dehydration, and has considerable advantages over intravenous fluid therapy in reducing complications associated with the treatment of hypernatraemia, in promoting rapid correction of ...

What are the recommendations for fluid replacement?

According to NATA(27), to guarantee the hydration status, the athletes should ingest approximately 500 to 600 mL of water or other sports drink 2 to 3 hours prior to exercise and 200 to 300 mL 10 to 20 minutes prior to exercise. The fluids replacement should be close to the losses by sweating and by urine.

What is the substitute for IV fluid?

Abstract. Intravenous fluid therapy is particularly effective in reversing severe dehydration due to diarrhoea, but it can be replaced by oral rehydration, with the advantages of lower risks and costs, in the treatment of mild, moderate and some severe cases of dehydration.

Why is fluid management important?

Fluid management is an essential aspect for any patient admitted to the hospital. If possible, patients should take fluids enterally since this is the natural route of fluid intake. However, many patients who are sick enough to need admission to the hospital might have a reason they cannot tolerate oral intake.

What are the preferable IV solution to be Infuse to a patient experiencing hypovolemic shock?

Isotonic crystalloid solutions are typically given for intravascular repletion during shock and hypovolemia. Colloid solutions are generally not used. Patients with dehydration and adequate circulatory volume typically have a free water deficit, and hypotonic solutions (eg, 5% dextrose in water, 0.45% saline) are used.

Which of the following is the preferred in hospital fluid for resuscitation in hemorrhagic shock?

Lactated Ringer's solution is the most widely available and frequently used balanced salt solution for fluid resuscitation in hemorrhagic shock. It is safe and inexpensive, and it equilibrates rapidly throughout the extracellular compartment, restoring the extracellular fluid deficit associated with blood loss.

What is the preferred initial fluid for shock resuscitation?

Background: Current guidelines for the management of patients with severe sepsis and septic shock recommend crystalloids as the initial fluid solution of choice in the resuscitation of these patients.

Why is fluid replacement important?

Fluid replacement is also indicated in fluid depletion due to hemorrhage, extensive burns and excessive sweating (as from a prolonged fever), and prolonged diarrhea (cholera). During surgical procedures, fluid requirement increases by ...

What is ORT treatment?

Oral rehydration therapy (ORT) is a simple treatment for dehydration associated with diarrhea, particularly gastroenteritis /gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth. For most mild to moderate dehydration in children, the preferable treatment in an emergency department is ORT over intravenous replacement of fluid.

What happens if you start vasopressors in the first hour of sepsis?

Initiation of vasopressors within the first hour of sepsis can lead to poor organ perfusion and poor organ function. Late initiation of vasopressor can lead to organ damage and increase the risk of death. Frequent monitoring of fluid status of the patient is required to prevent fluid overload.

What is fluid overload?

Fluid overload is defined as an increase in body weight of over 10%. Aggressive fluid resuscitation can lead to fluid overload which can lead to damage of multiple organs: cerebral oedema, which leads to delirium; pulmonary oedema and pleural effusion, which lead to respiratory distress; myocardial oedema and pericardial effusion, which lead to impaired contractility of the heart; gastrointestinal oedema, which leads to malabsorption; hepatic congestion, which leads to cholestasis and acute kidney injury; and tissue oedema, which leads to poor wound healing. All these effects can cause disability and death, and increase in hospitalisation costs.

What is fluid challenge?

Fluid challenge is the procedure of giving large amounts of fluid in a short period of time. However, 50% of patients do not respond to fluid challenge. Additional fluid challenges only causes fluid overload. However, there is no gold standard on determining the fluid responsiveness.

What is maintenance IV fluid?

Maintenance fluids are used in those who are currently normally hydrated but unable to drink enough to maintain this hydration. In children isotonic fluids are generally recommended for maintaining hydration. Potassium chloride and dextrose should be included. The amount of maintenance IV fluid required in 24 hours is based on the weight of the patient using the Holliday-Segar formula. For weights ranging from 0 to 10 kg, the caloric expenditure is 100 cal/kg/day; from 10 to 20 kg the caloric expenditure is 1000 cal plus 50 cal/kg for each kilogram of body weight more than 10; over 20 kg the caloric expenditure is 1500 cal plus 20 cal/kg for each kilogram more than 20. More complex calculations (eg, those using body surface area) are rarely required.

What happens if you use mechanical ventilation?

The use of mechanical ventilation in such case can cause barotrauma, infection, and oxygen toxicity, leading to acute respiratory distress syndrome.

When was IV fluid first used?

The earliest reported use of IV fluid dates back to 1832 during the cholera pandemic in England. A British physician named Thomas Latta noticed that “injecting a weak saline solution into the veins of the patient had the most wonderful and satisfactory effect.” 3 He used a solution that was composed of “two drams of muriate of soda and two scruples of subcarbonate of soda in six pints of water.” 4 Since 1832, many versions of salt solutions were created for intravenous therapy.

Why should a brain injury patient not receive hypotonic fluids?

Brain-injured patients (including traumatic brain injury, subarachnoid hemorrhage, subdural hemorrhage, intraparenchymal hemorrhage) should not receive hypotonic fluids because of the risk of cerebral edema. Therefore, saline (or Plasmalyte if available) would be preferable over lactated Ringer’s for brain-injured patients.

Who was the physiologist who used saline as a solution for lysis?

The justification for its use was based on experiments done by a Dutch physiologist named Hartog Jakob Hamburger. Hamburger did experiments examining the lysis of erythrocytes in solutions with different concentrations of saline.

How many liters of NS is used annually?

Intravenous fluid administration is the second most common medical intervention next to supplemental oxygen. 1 Over 200 million liters of normal saline (NS) is used in the United States annually. 2 Intravenous fluids, like any other drug, should be given with thought and knowledge about the effects and sequelae to your patient.

What is peripherally shut down?

In the management of peripherally shut down patients, this simple measure can facilitate rapid intravenous access in both prehospital and hospital environments when peripheral access may not have been achieved otherwise. Furthermore, it could circumvent the need for a central venous line which is both time consuming and not without complications. As central access and monitoring would most likely be later needed in such critically ill patients, this technique may provide a bridge for intravenous therapy until central access is achieved under more stable clinical circumstances reducing the risk of line insertion complications.

Can ultrasound be used for intravenous access?

Ultrasonography has been used for guided peripheral access but has shown no advantage being user-dependant. 1#N#,#N#2

Why should intravenous access be justified?

Generally accepted reasons include: Volume infusion therapy, such as what might be needed in post resuscitation care or closed-container hypotension. Administering intravenous medications.

Why do EMS practitioners have IV access?

Some EMS practitioners will begin IV access in the field so that hospital personnel can begin blood transfusions sooner. One study concluded obtaining a prehospital IV was not associated with more rapid initiation of blood products in the ED. [9] IV access and medical patients.

What percentage of IVs are not used?

Studies show that up to 83 percent of prehospital IVs are not used. In many situations, the use of a saline lock may be a better approach to an intravenous fluid line, such as the renal patient with pulmonary congestion. [12,13,14]

What are the complications of IV access?

Common IV access complications#N#Establishing intravenous access has a fair number of complications, some of which can be quite serious. Examples include: 1 Catheter shear and potential plastic embolism 2 Thrombophlebitis (redness and pain) 3 Extravasation (leakage of fluid/infiltration) 4 Bruising/ecchymosis at the puncture site 5 Infection, both localized and systemic 6 Volume overload 7 Potential for needle-stick injury for EMS providers

Why is KVO abolished?

The 2006 Institute of Medicine (IOM) Safe Practice Report recommends that the practice of using the flow rate terms such as "keep vein open" (KVO,, "to keep open" (TKO), and "wide open" (WO), will be abolished because they do not provide a specific flow rate or volume. [1] .

Is intravenous therapy invasive?

As patient care advocates, EMS providers are charged with applying current science to established practice; establishing vascular access is no different. As invasive – and potentially harmful to the patient – as it is, intravenous therapy should be performed only when medically necessary, and under stringent guidelines.

Is IV therapy good for prehospital patients?

While there are some situations where prehospital IV therapy may be helpful, there are many more where there is either no benefit, or worse, potential harm to the patient. EMS professionals must be fervent in their adherence to evidence-based practice as they apply their practice to the prehospital patient.

What is the recommended initial vasopressor for septic shock?

The initial bolus of isotonic crystalloid in severe sepsis and septic shock should be at least 30 mL/kg. Norepinephrine is the recommended initial vasopressor in septic shock.

What is the second choice agent for septic shock?

Epinephrine is considered the second-choice agent for septic shock. 14 Epinephrine is used for the treatment of patients in cardiac arrest. 17. Adverse reactions and side effects include increased afterload, wall tension, and heart rate that lead to increased coronary oxygen demand and potential ischemia.

What are the physiological responses to shock?

Physiologic Response to Shock. A variety of biochemical and hemodynamic responses can occur in shock. Some responses may produce a temporary increase in perfusion to some vascular beds, sometimes termed compensatory and helpful. However, the responses cannot be maintained and may lead to further harm if sustained.

What is volume resuscitation?

Volume resuscitation is the initial therapy in the resuscitation of patients with septic shock. The inciting infection should be identified, with the early administration of antibiotics chosen according to expected pathogens. Surgical removal of infected tissue may be necessary for localized infections.

What is shock in medical terms?

Shock is the condition in which perfusion to the tissues is not matched with the demand for oxygen; simply, oxygen delivery (DO 2) does not meet oxygen consumption (VO 2 ). Oxygen delivery is determined by the oxygen content in the blood (CaO 2) and the cardiac output (CO): DO 2 = CO × CaO 2.

Is norepinephrine safe for bowel ischemia?

This hesitancy to utilize norepinephrine earlier in shock therapy mostly stemmed from fear of ischemic events, including bowel and limb ischemia. The current experience is that norepinephrine is safe to use in patients who have been adequately volume resuscitated, which appears to mitigate ischemic potential.

Is anaphylaxis a form of distributive shock?

Inotropic and vasopressor support is often necessary. Anaphylaxis is a form of distributive shock caused by an immediate-type hypersensitivity response to an allergen, provoking a severe, systemic inflammatory response.

Overview

By mouth

Oral rehydration therapy (ORT) is a simple treatment for dehydration associated with diarrhea, particularly gastroenteritis/gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth. For most mild to moderate dehydration in children, the preferable treatment in an emergency department is ORT over intravenous replacement of fluid.

Intravenous

Clinical uses

Fluid overload

Other treatments

See also