Question of the Week

Question :
Posted On : 18 Sep 2017
what IV fliuid should we use in near drown pt who drown while bathing in GANGA river or in swimming pool or in ponds
Expert Answer :
The difference in pathophysiology of aspiration of fresh water {hypotonic} and salt water {hypertonic} have little clinical significance in humans because the outcome is the same. Fresh water drowning produces hemodilution and intravascular hemolysis. Aspiration of large amounts of sea water leads to hemoconcentration and hypovolemia.
When fresh water is aspirated {22 cc, kg} the hypotonic fluid is absorbed through the pulmonary capillary membrane resulting in the wash out of the lung surfactant and alveolar collapse, intrapulmonary shunting, and hypoxia. With salt water drowning the osmotic gradient favor transudation of fluid into alveoli leading to pulmonary edema and hypoxemia. The hypertonic fluid also causes damage to pulmonary capillary membrane with leakage of plasma protein into the aveoli. The net result of drowning is ventilation perfusion mismatch. intrapulmonary shunting, and hypoxemia. Intravenous fluids with Normal Saline or Ringer`s lactate help to maintain circulation and prevent brain edema.
Answer Discussion :
Vitthal Mali
normal saline
4 years ago
Ali Kadhem
normal saline
4 years ago
bhakti bhuva
ringer lactate
4 years ago
jagdeep Singh
4 years ago
Sanjay yadav
ringer lactate as chloride content is high in Ganga and pond water
4 years ago

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