tailieunhanh - Ebook Boh’s pharmacy practice manual - A guide to the clinical experience (4E): Part 2

(BQ) Part 2 book “Boh’s pharmacy practice manual - A guide to the clinical experience” has contents: Fluid and electrolyte therapy, enteral nutrition, parenteral nutrition, pharmacy calculations, clinical pharmacokinetics, clinical drug monitoring, pain management, vaccines and pharmacists as immunizers, and other contents. | 10 Fluid and Electrolyte Therapy Pauline A. Low This chapter provides reference information to assess each of the general approach elements to intravenous (IV) fluid and electrolyte therapy included in Box . The information in this chapter must be used in the context of good clinical judgment. Fluid Distribution Within the Body Total Body Water ■■ The amount of water present within the body is described as total body water (TBW). TBW for adults is estimated by using Equation . Total body water (L) = Adult males: weight (kg) × Adult females: weight (kg) × ()   ■■ The percentage of body weight composed of water, declines as we age. Newborns typically have around 75% to 85% body weight as water, whereas adult males have 60% and females about 40% (variable; these estimations are not valid for obese patients or patients with larger than average muscle mass).1 ■■ Most body water is housed within cells. Since adult males generally have a higher muscle cell mass than adult females, they will have a higher volume of body water (accounted for in the equation by applying a higher multiplication factor). ■■ TBW is used to help select an appropriate IV fluid as well as to ­provide information for fluid and electrolyte dosing. 360 360 1/21/2014 9:48:07 AM Chapter 10   Fluid and Electrolyte Therapy 361 Box   General Approach to IV Fluid/Electrolyte Therapy 1.  Determine clinical goals based on the specific patient. 2.  Identify which IV fluids and/or electrolytes will assist with achieving clinical goals and make appropriate selection. Consider the following: ■■ IV access (central or peripheral IV line) ■■ Oral intake capability of patient ■■ All sources of fluids and/or electrolytes ■■ IV fluid and electrolyte distribution characteristics 3.  For fluids: determine volume needs and the associated fluid rate. ■■ Consider maintenance fluid needs as well as replacement of excessive losses and requisite electrolyte content 4.  For .