Description of Solutions for Correcting
Session 23: Description of Solutions for Correcting
Electrolyte Imbalance
Total Session Time: 120 minutes
Prerequisites
Learning Tasks
By the end of this session students are expected to be able to:
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Objectives
Presentation/ Indications of Solutions for Correcting
2 20 minutes
Buzzing Electrolyte Imbalance
Presentation/ Contraindications of Solutions for Correcting
3 20 minutes
brainstorming Electrolyte Imbalance
Dose, Dosage and Course of Solutions for
4 30 minutes Presentation
Correcting Electrolyte Imbalance
Presentation/ Side Effects and Adverse Effects of Solutions
5 15 minutes
brainstorming for Correcting Electrolyte Imbalance
Interactions and Precautions of Solutions for
6 20 minutes Presentation
Correcting Electrolyte Imbalance
7 05 minutes Presentation Key Points
8 05 minutes Presentation Evaluation
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SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Objectives (5 minutes)
READ or ASK students to read the learning objectives and clarify
ASK students if they have any questions before continuing.
STEP 2: Indications of Solutions for Correcting Electrolyte Imbalance
(20 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the following questions for 2 minutes
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
solution, sodium chloride solution, potassium chloride solution and potassium citrate oral
solution
o Administration of concentrated drugs which require dilution
hypoglycemic effect)
o Correction of electrolyte and acid-base disorders/imbalances for example in
conditions like severe diarrhea, severe vomiting
o To correct hypotension by restoring blood volume in conditions like anaphylactic
shock, poisoning
o Correction of shock and establish proper tissue perfusion
o When a quick effect of a drug is required through I.V administration
o Principal fluid used for intravascular resuscitation and replacement of salt loss e.g.
diarrhoea and vomiting
o Hypovolemic shock
o Stroke
o Used as a sterile irrigation medium
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o Hypovolemic shock
o Burns
o Diarrhoea
o Intraoperative
o Intravenous fluid and electrolyte replacement
o As a source of bicarbonate in treatment of mild to metabolic acidosis associated with
potassium deficiency
o Primarily used to maintain water balance in patients who are not able to take anything
by mouth i.e. starvation deficit
o Commonly used post-operatively in conjunction with salt retaining fluids i.e. saline
o As Intravenous solution for fluid replenishment
o caloric supply in single dose container for intravenous administration
o As parenteral nutrient
o Hypoglycemia
o Status epilepticus
o Coma
o Altered mental status
o Similar indications to 5% dextrose
o Provides Na+ 30mmol/l and Cl- 30mmol/l i.e. a sprinkling of salt and sugar
o Does not commonly cause water or salt overload
o Hypokalemia
STEP 3: Contraindications of Solutions for Correcting Electrolyte
Imbalance (20 minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
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o Severe Hypertension
o Pulmonary edema
o Congestive cardiac failure
o Oedema
o Severe renal impairment
o Liver cirrhosis
o Hyperglycemia
o Cerebral vascular accident in presence of normal blood sugar.
o Hyperglycemia
o Increased Intracranial pressure(ICP)
o Intracranial hemorrhage
o Known hypersensitivity to sodium lactate
o Congestive heart failure
o Severe renal impairment
o Lactic acidosis
STEP 4: Dose, Dosage and Course of Solutions for Correcting Electrolyte
Imbalance (30 minutes)
requirements]. Regarded as ‗electrolyte free‘ – contains NO Sodium, Potassium, Chloride
or Calcium
(lactate) 29mmol
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STEP 5: Side Effects and Adverse Effects of Solutions for Correcting
Electrolyte Imbalance (15 minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
imbalance?
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
o Common cause of iatrogenic hyponatremia in surgical patients.
o Reactions which may occur because of the solution or the technique of administration
include febrile response, infection at the site of injection, venous thrombosis or
phlebitis extending from the site of injection, extravasation, and hypervolemia
o Hyponatremia
o Pain, burning and phlebitis at site of injection
o Hyperglycemia especially with Dextrose 50%
STEP 6: Description of Interactions and Precautions of Solutions for
Correcting Electrolyte Imbalance (20 minutes)
o Drugs should only be added to infusion containers when constant plasma
concentrations are needed or when the administration of a more concentrated solution
would be harmful
o In general, only one drug should be added to any infusion container and the
components should be compatible
o Ready-prepared solutions should be used whenever possible
o Drugs should not normally be added to blood products, mannitol, or sodium
bicarbonate
o Solutions should be thoroughly mixed by shaking and checked for absence of
particulate matter before use
o Strict asepsis should be maintained throughout and in general the giving set should
not be used for more than 24 hours (for drug admixtures)
o The infusion container should be labelled with the patient‘s name, the name and
quantity of additives, and the date and time of addition (and the new expiry date or
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time). Such additional labelling should not interfere with information on the
manufacturer‘s label that is still valid
o When possible, containers should be retained for a period after use in case they are
needed for investigation
o It is good practice to examine intravenous infusions from time to time while they are
running. If cloudiness, crystallization, change of colour, or any other sign of
interaction or contamination is observed the infusion should be discontinued
o The accidental entry and subsequent growth of micro-organisms converts the
infusion fluid pathway into a potential vehicle for infection with micro-organisms,
particularly species of Candida, Enterobacter, and Klebsiella
o When drugs are added to infusion fluids or when infusion fluids are mixed; physical
and chemical incompatibilities may occur with loss of potency, increase in toxicity, or
other adverse effect. The solutions may become opalescent or precipitation may occur
as a result of pH, concentration changes, ‗salting-out‘ effects, complexation or other
chemical changes
o A number of preparations undergo significant loss of potency when added singly or
in combination to large volume infusions. Examples include ampicillin in infusions
that contain glucose or lactates
o Because of the large number of incompatibilities, drugs should not normally be added
to blood and blood products for infusion purposes. Examples of incompatibility with
blood include hypertonic mannitol solutions (irreversible crenation of red cells),
dextrans (interference with cross-matching), glucose (clumping of red cells), and
oxytocin (inactivated)
o To be avoided in hypovolemic shock as it is ineffective in raising blood volume and
leads to urinary fluid loss
o Avoided in stroke.
o Few known significant drug interactions
o Possible interaction with antidiabetic drugs
o Co-medication of drugs inducing sodium retention may exacerbate any systemic
effects
STEP 7: Key Points (5 minutes)
on composition and concentrations
imbalances
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STEP 8: Evaluation (5 minutes)
(Ringer‘s Lactate) and Dextrose?
compound (Ringer‘s Lactate) and Dextrose?
imbalance?
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References
Ministry of Health and Social Welfare. (2013). Standard Treatment Guidelines & National
Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania
government printers.
Pharmacotherapy: a pathophysiologic approach (9th ed.). New York, McGraw-Hill
Education.
Sally S.R & Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York,
Lippincott Williams and Wilkins
School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.).
Dar es Salaam, ARDHI University press.
The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, the Extra
Pharmacopoeia (5TH ed). London, pharmaceutical press.
The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary
(59th ed). London, BMJ Group and RPS Publishing.
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