Ep 67 IV Fluids in 5ish Minutes and the Hypotonic Hippo

IV Fluids in 5ish Minutes and the Hypotonic Hippo A quick rundown on some often confused terms hypotonic, hypertonic, and isotonic as it relates to IV fluids. Find the book here: https://geni.us/iA22iZ  or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd Need more help; you can find many of my mnemonics books on Audible that you might be able to get your first for free if you've never had one before.  https://www.audible.com/pd/Memorizing-Pharmacology-Mnemonics-Audiobook/B07DLGC8MP?source_code=AUDFPWS0223189MWT-BK-ACX0-118296&ref=acx_bty_BK_ACX0_118296_rh_us  Here is the Link to my Pharmacy Residency Courses: residency.teachable.com   Auto Generated Transcript: Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com. Let's get started with the show. Okay, we're gonna do some IV fluids mnemonics in five minutes or less. You may have heard of the hypotonic hippo. I'll explain what that is but I'm gonna bet that you've probably seen something like this slide before where you see hypotonic and you see this water going into a cell and the cell lysing or exploding. You're going to see isotonic where water is going in water's going out it's about the same and hypertonic where the water is mostly just going out it's causing crenation which is the word for those skinny cells and creating those skinny cells. So again it's where is the solute the water follows the solute so there is more solute in the cell that's why it goes into the first cell and explodes it's an even amount in both cases so that's why it goes in and out in isotonic and hypertonic it's there's more solute on the outside so the outside is the big one there. So what I've seen are images for hypotonic you think of a hippo because it also has many of the letters of hypo and we're thinking about the water going into hippo and making it large. The isosceles triangle is one where the sides are equal and so we're thinking inside and outside the cell is equal for isotonic and then you see what I did here that's a skinny cell a lot of people will talk about somebody who's a runner and how they're skinny because they're really hyper but in general as a runner I'm not as much hyper as I'm just very consistent so again skinny cell is what you're going to see. Last but let me give you something that's a little more tangible than even that when you have just tap water which has very little solutes in it at all that's hypotonic to your body. You are isotonic yourself okay and then we talk about the ocean uh the ocean would be a lot like three percent saline which we'll talk about in a minute that's Ocean City Maryland uh where I used to go for Summers or we'd go for a week in the summer and the Great Salt Lake is below that that has quite a bit more salinity than even the ocean. And then if you talk about the Dead Sea that's probably about a third sodium chloride you can actually lay in it and you will float on it there's so much salt in there so we're just trying to figure out what the middle is mathematically and I know people don't like percentages and they certainly don't like fractions and you betcha they don't like decimals over fractions so 0.45 percent half normal saline is really 0.45 over 100 point nine percent sodium chloride is 0.9 over 100 and hypertonic saline is three over one hundred. And you could expand it out to a hundred thousand so you could get whole numbers with 0.225 and all of those but the most important thing to know is that the middle, the 0.9 percent, that's isotonic 0.45 half normal is hypotonic and saline three percent is hypertonic D5W has something very similar where D5W which is which is five percent dextrose and water uh that's in the middle that's isotonic hypotonic is 2.5 dextrose and hypertonic is you know 50 is one example uh d50w. The important thing is that your middle is D5W just as it was 0.9 for the sodium chloride so here are a couple that we're going to look at there's not a ton here but on the left hypotonic point four five percent sodium chloride and D 2.5 W in the middle isotonic 0.9 percent NaCl D5W lactated ringers we'll talk about it's also Ringer's lactate same thing it's a synonym and then albumin five percent so a colloid. And then three percent NaCl and d50w as hypertonic we'll talk a little bit about what they're for okay. The first kind of key point is that if we have a hypertonic condition that's when we're going to use a hypotonic solution so 0.45 NaCl half normal we could use in hypertonic extracellular dehydration in D 2.5 W same thing dehydration we don't want to administer though with blood products it will cause hemolysis okay but again a hypotonic solution for a hypertonic condition with an isotonic solution we have an isotonic condition 0.9 saline is you know we could replace isotonic water loss okay D5W same thing but we could also help with hypoglycemia insulin shock you know dehydration certainly but I recommend thinking it of it as g5w or D glucose instead because it's just one of the enantiomers or mirror image of the glucose molecule lactated ringers or ringers lactate this is for nausea and vomiting Burns lactase lactate is a base and buffers Burns metabolic acidosis so it's an excellent choice so think of a firehouse alarm ringing when there is a fire and people get burnt. Albumin five percent is for hypovolemia hypotension hypoproteinemia to ascites so we expect a loss of volume right that's what we're expecting this drug is for so the Al from albumin for a loss and then the um from volume should help you Al's Barbecue for protein loss so barbecue has protein in it and ALB are the first three letters of Al's Barbecue and finally albumin and ascites both start with an A okay. Last piece is the hypertonic solution so for a hypo condition three percent saline can be used for hyponatremic encephalopathy traumatic brain injury cerebral edema hypoglycemia certainly faster than D5W for d50w and again g50w or D glucose I recommend you remember it that way and then the hydro was a three-headed monster from mythology and so we have three pathophysiologic head issues the encephalopathy the brain injury and the edema hopefully the Hydra helps you remember it. Again this is for informational purposes only and should not be relied on for medical advice if you have a medical problem consult a medical professional. Thanks for listening to the memorizing pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile and thanks again for listening.   Like to learn more? Find my book here: https://geni.us/iA22iZ or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd Here is the Link to my Pharmacy Residency Courses: residency.teachable.com