Acute hypovolemia

Resuscitation from acute hypovolemia or hemorrhagic shock... 

Infusion of a tHb in resuscitation from acute hypovolemia or hemorrhagic shock, clinical indications... 

In summary, the use of tHb solutions to counter acute hypovolemia and concurrent global ischemia attendant to trauma or surgery has met with widely... 

Patients will be in acute distress although symptoms and signs will vary depending on the severity of the hypovolemia and whether the etiology is hemorrhagic versus non-hemorrhagic. 

Budesonide, Oral (Entocort EC) [Anti-inflammatory> Corticosteroid] Uses Mild-mod Crohn Dz Action Steroid, anti-inflammatory Dose Adults. Initial, 9 mg PO qAM to 8 wk max maint 6 mg PO qAM taper by 3 mo avoid grapefruit juice Contra Active TB and fungal Infxn Caution [C, /-] DM, glaucoma, cataracts, HTN, CHF Disp Caps SE HA, cough, hoarseness, Candida Infxn, epistaxis Interactions T Effects W/ erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, grapefruit EMS Monitor ECG and BP for signs of electrolyte disturbances and hypovolemia OD Acute OD unlikely to cause a problem, chronic OD can reduce natural production of certain steroids symptomatic and supportive... 

Shock is a complex acute cardiovascular syndrome that results in a critical reduction in perfusion of vital tissues and a wide range of systemic effects. Shock is usually associated with hypotension, an altered mental state, oliguria, and metabolic acidosis. If untreated, shock usually progresses to a refractory deteriorating state and death. The three major mechanisms responsible for shock are hypovolemia, cardiac insufficiency, and altered vascular resistance. Volume replacement and treatment of the underlying disease are the mainstays of the treatment of shock. Although sympathomimetic drugs have been used in the treatment of virtually all forms of shock, their efficacy is unclear. 

Furosemide Loop diuretic Decreases NaCI and KCI reabsorption in thick ascending limb of the loop of Henle in the nephron (see Chapter 15) Increased excretion of salt and water reduces cardiac preload and afterload reduces pulmonary and peripheral edema Acute and chronic heart failure severe hypertension edematous conditions Oral and IV duration 2-4 h Toxicity Hypovolemia, hypokalemia, orthostatic hypotension, ototoxicity, sulfonamide allergy... 

Na/K/2CI transporter in the ascending limb of Henle s loop excretion, some wasting, hypokalemic metabolic alkalosis, increased urine Ca and Mg peripheral edema, hypertension, acute hypercalcemia or hyperkalemia, acute renal failure, anion overdose duration of action 2-4 h Toxicitiy Ototoxicity, hypovolemia, wasting, hyperuricemia, hypomagnesemia... 

Docusate Calcium (Surfak)/Docusate Potassium (Dialose)/ Docusate Sodium (DOSS, Colace) [Emollient Laxative/Fecal Softener] Uses Constipation adjunct to painful anorectal conditions (hemorrhoids) Action Stool softener Dose Adults. 50-500 mg PO + daily qid Peds. Infants-3 y 10-40 mg/24 h daily qid 3-6 y 20-60 mg/24 h + daily qid 6-12 y 40-120 mg/24 h + daily qid Caution [C, ] Contra Use w/ mineral oil intestinal obst, acute abd pain, N/V Disp Caps, syrup, Liq, soln SE Rare abd cramping, D Interactions T Absorption of mineral oil EMS Monitor for Sxs of electrolyte disturbances and hypovolemia d/t D OD May cause N/V/D and abd pain symptomatic and supportive... 

Uses Acute CHF, ischemic cardiomyopathy Action Inotrope w/ vasodilator Dose IV bolus 0.75 mg/kg over 2-3 min maint 5-10 mcg/kg/min, 10 mg/kg/d max i if CrCl <10 mL/min Caution [C, ] Contra Bisulfite allergy Disp Inj SE Monitor fluid, electrolyte, renal changes Interactions Diuretics cause significant hypovolemia T effects OF cardiac glycosides EMS Avoid diuretic use, can cause profound hypovolemia incompatible w/ dextrose solns monitor ECG for hypokalemia (flattened T waves) OD May cause profound hypotension use IV fluids w/ caution d/t fluid buildup in lungs, pressors may be used... 

UTI, acute exacerbation of chronic bronchitis prophylaxis in transurethral procedures Action Quinolone antibiotic 4- DNA gyrase. Dose 400 mg/d PO w/ renal insuff, avoid antacids Caution [C, -] Interactions w/ cation-containing products Contra Quinolone allergy, children <18 y,T QT interval, i K+ Disp Tabs SE N/V/D, abd pain, photosens, Szs, HA, dizziness, tendon rupture, peripheral neuropathy, pseudomembranous colitis, anaphylaxis Interactions T Effects W/ cimetidine, probenecid T effects OF cyclosporine, warfarin, caffeine i- effects W/ antacids EMS Monitor ECG for TQT interval, esp in pts taking class IA/m antiarrhythmics monitor ECG and BP for signs of hypovolemia and electrolyte disturbances (hypokalemia) d/t D T risk of photosensitivity Rxns OD May cause N/V/D, confusion and Szs symptomatic and supportive... 

Patients with nephrotic syndrome can develop acute renal failure as a consequence of intravascular hypovolemia and/or sepsis with subsequent prerenal azotemia or acute tubular necrosis. Renal hypoperfusion in these patients can be potentiated by the administration of diuretics, inhibitors of angiotensin-converting... 

Acute ciclosporin-induced nephrotoxicity, causing reduced renal function, develops within the first month, and includes a dose-related rise in serum creatinine concentrations and hyperkalemia. Fatal acute tubular necrosis has also been noted after very high intravenous doses (SEDA-19, 345). Although it is clinically often difficult to differentiate from acute allograft rejection in renal transplant patients, the alteration in renal function promptly resolves on ciclosporin withdrawal or dosage reduction, and initial acute renal insufficiency is not clearly associated with the development of subsequent chronic renal dysfunction (93). Several conditions, such as pre-existing hypovolemia, concomitant diuretic treatment, or renal artery stenosis, are susceptibility factors. 

Priano LL Effect of halothane on renal hemodynamics during normovolemia and acute hemorrhagic hypovolemia. Anesthesiology 1985 63(4) 357-63. 

The resuscitation phase aims to restore circulating volume. There are two ways to think about the treatment of hypovolemia, both of which result in similar treatment patterns. Hypovolemic horses typically require 20-80 ml/kg of crystalloid fluids acutely. 

Hypersensitivity to amide-type local anesthetics, Adams-Stoke syndrome, supraventricular arrhythmias, Wolf-Parkinson-White syndrome. Spinal anesthesia contraindicated in septicemia. Caution Dosage should be reduced for elderly, debilitated, acutely ill safety in children has not been established. Severe renal/hepatic disease, hypovolemia, CHF, shock, heart block, marked hypoxia, severe respiratory depression, bradycardia, incomplete heart block. Anesthetic solutions containing epinephrine should be used with caution in peripheral or hypertensive vascular disease and during or following potent general anesthesia. Sulfite sensitivity or asthma for some local and topical anesthetic preparations. Tartrazine or aspirin sensitivity with some topical preparations. Anxiety, insomnia, apprehension, blurred vision, loss of hearing acuity, and nausea CNS depression, convulsion and respiratory depression... 

Adverse effects hypotension, hypovolemia, dry cough (30% incidence with ACEIs, much less with AT-1 antagonists), hyperkalemia, acute renal failure (especially in renal artery stenosis), angioedema. 

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