HYPERTONIC AND

HYPERONCOTIC FLUIDS TO
REPAIR BLEEDING

Feny Cahyani (H1A015023)

Pembimbing
dr. Hijineli, Sp.AN
INTRODUCTION
BLEEDING

The goals of resuscitation in the

Bleeding is the discharge of blood
from blood vessels due to damage
to blood vessels.
 Blood loss can be caused by
internal and external bleeding.
face of hemorrhagic shock are
restoring end-organ perfusion
and maintaining tissue
oxygenation while attempting
definitive control of bleeding.
CON’T
Resuscitatio
n Fluids

Isotonic crystalloids natural and artificial colloids

Hypertonic and Hyperonotic solutions

Artificial oxygen carriers

CON’T

Hyperto is a crystalloid intravenous fluid consisting of NaCl dissolved

●
●

in water with higher sodium concentrations compared to

normal blood serum where 7.5% sodium chloride has an

nic
osmolality of >340 mOsm / L which is said to have been
used successfully for hemorrhagic shock.

Hyperon ●
●fluid, which contains particles large enough to exert oncotic
pressure across the microvascular membrane. compared to
crystalloids which have a greater intravascular effect.

cotic
●Hyperonotic
●
colloid fluids such as dextran, hydroxyethyl
starches (HES), and albumin 20% or 25%

Hypertonic intravenous saline can be extended by mixing it with

colloids.
DISCUSSION
Type of
Bleeding

External Bleeding.

●
Occurs because of damage to the walls of blood vessels accompanied by skin damage

Internal Bleeding

●
Bleeding that cannot be seen on the outside of the body
CON’T
Estimated
Blood Loss

Cla Cla Clas Clas

ss I ss II s III s IV
●
●15-30% (750-
●
●30-40% (1500- ●
●>40% (>2000
●
●15% (750 ml) 2000 ml) ml)
●fluid therapy
●
1500 ml) ●fluid therapy+
● ●fluid therapy +
●

●fluid therapy
●
blood blood
CON’T

Hypovolemic shock is a system of disruption of circulation resulting

from increased blood volume.

This can occur due to reduced bleeding in the blood vessels.

This can occur due to

 massive bleeding
 loss of blood plasma
 Extracellular fluid loss

The most common cause of hypovolemic shock is blood loss

due to trauma including blood loss during or after surgery
CON’T
Fluid therapy

Crystaloid (Coloid)
(Hypertoni Hyperonco
c) tic
Dextran,

NaCl 3%
●
●

● ●Hydroxyethyl starches (HES)

●

●Albumin 20% or 25%

●
CON’T
Hypertonic

•This liquid contains sodium which is the main

extracellular ion.

•Therefore giving hypertonic sodium will attract

intracellular fluid into extracellular.

•This event is known as internal infusion.

•Besides that, hypertonic sodium liquid has positive

inotropic effects such as vasodilating pulmonary and
systemic blood vessels.
CON’T
Hyperoncotic
• HES
• Albumin
• HES is formed from the
• Albumin 25% if given
hydroxylation of
intravascular will increase
aminopectin, a branch of
intravascular contents
glucose polymer. In clinical
close to 5x the amount
studies it is reported that
given. This is due to an
HES is a quite effective
increase in plasma oncotic
volume expander. The
pressure. This increase
intravascular effects can
results in the
last 3-24 hours.
intersocation of
Intravasular fluid binding
intravascular fluid as
exceeds the amount of fluid
long as the amount of
given because of its higher
intersisial fluid is sufficient.
oncotic pressure
CON’T
Hyperoncotic
• Dextran
• dextran 40 and 70.
• Dextran 70 has a molecular weight of 70.000 found in
concentrations of 6% in physiological salts, while
dextran 40 has a molecular weight of 40.000 available in
concentrations of 10% in physiological salts or 5%
glucose.
• Dextran 70 is more effective as a volume expander
and is the best choice compared to dextran 40.
• Giving dextran for fluid resuscitation in shock and
emergency results in hemodynamic changes in the form of
increased oxygen transport.
CONCLUSION
 Hypovolemic shock is the disturbed circulatory system
of increased blood volume.
 This can occur due to bleeding in blood vessels that are
reduced due to massive bleeding or loss of blood
plasma
 Fluid resuscitation is the treatment of hypovolemic
shock.
 The purpose of fluid resuscitation is to replace lost
blood volume and restore organ perfusion.
 Fluid therapy that can be used can be hypertonic and
hyperoncytic fluids.
THANK YOU