Crystalloid aur Colloid Kya Hote Hain
Crystalloids chhote molecules wale intravenous fluids hain jo paani aur electrolytes contain karte hain aur semipermeable membranes ko freely cross kar sakte hain, jabki colloids bade molecules wale fluids hain jo intravascular space mein zyada der tak rehte hain. 1
Crystalloids Ki Types
Crystalloids teen main categories mein aate hain:
0.9% Sodium Chloride (Normal Saline) mein 154 mmol/L sodium aur 154 mmol/L chloride hota hai, osmolarity 308 mOsm/L ke saath 1, 2
Balanced Crystalloids jaise Ringer's Lactate mein sodium (130 mmol/L), potassium (4 mmol/L), chloride (108 mmol/L), calcium (0.9 mmol/L), aur lactate (27.6 mmol/L) buffer ke taur par hota hai, osmolarity 277 mOsm/L ke saath 1
Isofundine jaise balanced solutions mein sodium (145 mmol/L), potassium (4 mmol/L), chloride (127 mmol/L), calcium (2.5 mmol/L), acetate (27 mmol/L), gluconate (23 mmol/L), aur malate (5 mmol/L) hota hai 1
Colloids Ki Types
Colloids bade molecules wale synthetic ya natural fluids hain:
Hydroxyethyl Starches (HES) waxy starch se derived synthetic colloids hain jo plasma volume expansion ke liye use hote hain, average molecular weight 670,000 ke saath 2
Gelatins aur Dextrans bhi synthetic colloids hain jo volume expansion provide karte hain 3
Albumin aur Fresh Frozen Plasma (FFP) natural colloids hain jo plasma proteins contain karte hain 3
Clinical Practice Mein Kaunsa Use Karein
Crystalloids ko first-line fluid therapy ke taur par use karna chahiye kyunki mortality aur renal outcomes colloids ke comparison mein better ya similar hain. 1, 4
Crystalloids Ko Prefer Kyun Karein:
Balanced crystalloids mortality reduce karte hain (OR 0.84,95% CI 0.74-0.95) aur major adverse kidney events ko kam karte hain critically ill patients mein 5
Normal saline se balanced crystalloids prefer karne chahiye kyunki hyperchloremic metabolic acidosis ka risk kam hota hai 1, 3
Agar 0.9% saline use kar rahe hain, toh maximum 1-1.5 L tak limit rakhein 3, 4
Colloids Se Bachein:
Hydroxyethyl starches (HES) bilkul use nahi karne chahiye kyunki sepsis patients mein mortality increase hoti hai (relative risk 1.17,95% CI 1.01-1.36) aur renal replacement therapy ki zaroorat badh jati hai (relative risk 1.35,95% CI 1.01-1.80) 3, 2
European Medicines Agency ne 2013 mein recommend kiya tha ki HES ko volume resuscitation ke liye use nahi karna chahiye, khaas taur par sepsis patients mein 3
Gelatins se bhi renal failure ka risk badhta hai aur anaphylactic reactions zyada hote hain 3
Special Situations
Trauma aur Hemorrhagic Shock Mein:
Initial resuscitation ke liye crystalloid solutions use karein, blood loss ke saath 1.5:1 ratio mein 4
Permissive hypotension (systolic BP 80-90 mmHg) maintain karein jab tak bleeding control nahi ho jati, agar traumatic brain injury nahi hai 4
Traumatic Brain Injury Mein:
Hypotonic solutions jaise Ringer's Lactate avoid karein kyunki ye damaged cerebral tissue mein fluid shift kar sakte hain aur cerebral edema badha sakte hain 1, 3, 4
Isotonic crystalloids use karein mortality aur neurological prognosis improve karne ke liye 1
ESRD Patients Mein:
Balanced crystalloids jaise Plasma-Lyte ya Ringer's Lactate prefer karein 0.9% saline ke bajaye 5
Potassium content (4-5 mmol/L) balanced solutions mein generally concern nahi hai, even hyperkalemia-prone patients mein 1, 5
Common Pitfalls Se Bachne Ke Liye
High volumes of normal saline hyperchloremic acidosis, renal vasoconstriction, aur acute kidney injury cause kar sakta hai 3
Colloids ka routine use hemostasis par adverse effects dalta hai aur coagulation factors ko dilute karta hai 1, 4
Aggressive crystalloid resuscitation hydrostatic pressure badhata hai wounds par, blood clots dislodge kar sakta hai, aur coagulation factors dilute kar sakta hai 4