Travel Reference
In-Depth Information
The easiest and most reliable method for replacing fluids is to drink more. Almost any
nonalcoholicliquidissuitable,butfruitjuices,softdrinks,soups,andsimilarliquidsshould
be encouraged since water contains no electrolytes. (Coffee, tea, and hot chocolate are not
as satisfactory because they contain caffeine, a diuretic that increases renal fluid loss.)
Seriously ill individuals with very little appetite often refuse liquids and solid foods.
However, they can usually be persuaded to drink small quantities, just two or three sips, at
intervals of fifteen to twenty minutes. With tenacity, patience, and gentle encouragement,
such persons can be coaxed to drink several liters of fluid over a twenty-four hour period.
Some individuals, particularly those with intractable vomiting or in coma, are unable
to take fluids orally. If medical attention can be obtained within one or two days and
fluid losses are not increased, the intervening fluid depletion is usually not too severe.
However, longer periods without fluid, and disorders that increase fluid loss, can produce
severe dehydration. If drugs that control vomiting—odansetron disintegrating tablets (Zo-
franODT®),orCompazine®,orPhenergan®suppositories—arenotavailable,fluidsmust
be administered intravenously.
Only knowledgeable persons experienced with such therapy should attempt administer-
ing fluids intravenously. Fluids suitable for intravenous administration cannot be impro-
vised and would only be carried bya well-equipped expedition, although such fluids might
beobtained byairdrop. Such fluids are often left behind byexpeditions, andinsome popu-
lar areas a significant supply has accumulated. These fluids come from many nations with
labels printed in many languages, but the contents are usually stated in standard chemical
symbols or English.
The volume of fluids to be given intravenously must be determined each day. Fluids are
required to replace both normal and abnormal losses. Two liters of 5 percent glucose and
0.5 liter of an electrolyte solution (preferably a balanced salt solution, but normal saline if
only that is available) usually fulfill the body's daily needs when no abnormal losses are
occurring. Fluids lost through vomiting, diarrhea, or excessive perspiration should be re-
placed with an electrolyte solution. Excessive fluid loss through the lungs due to high alti-
tude should be replaced by a glucose solution since no electrolytes are lost with the mois-
ture in expired air.
Most electrolyte solutions contain little potassium. Individuals with poor kidney func-
tion cannot rid themselves of excessive potassium, which may rapidly accumulate to lethal
levels. However, persons with normal renal function excrete potassium in the urine. As a
result, blood potassium concentrations can fall to dangerously low levels during prolonged
intravenous fluid therapy if the potassium is not replaced. Therefore, individuals receiving
intravenous fluids for more than two to three days, or losing large volumes of fluid with
diarrhea, who have a normal urine volume, should receive an extra 15 to 20 mEq of po-
tassiumperliterofelectrolyte.(Theoccasionswhensuchpotassiumsupplementsareavail-
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