Choice of fluid My opinion says it is irrelevant to select You have to treat as per loss of electrolytes and not as per choice You have to consider the clinical status and vitals of pt Remember the comorbidies like diabetes and hypertension etc while infusing fluid Thus it is not correct to suggest particular fluid which can be RL NS DNS DEXTROSE ISOLYTE OR EVEN BT
Ringer Lactate. Its a mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure.
I V RL ,DNS . Maintain electrolytes balance. Keep watch on Input and out put. Requirement of calories must be looked out regularly
IV RL ..
Deficit fluid 1/3 rd G DW 2/3 G N S in 1 st 6 hrs then R L as maintenance fluid in 18 hrs
ADVISABLE AS. PER. THE. MEDICAL HISTORY. OF THE. CONCERNED. PATIENT....
In dehydration due to gastroenteritis, both water and electrolyte replacement is essential, and non-ORS solution fluids do not usually contain appropriate constituents. ORS solution was considered the appropriate fluid for oral rehydration.
Intravenous RL .
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Ativisha (Aconitum heterophyllum) Medicinal Usage bimbima.com Oct 14, 2017 10:27 PM Ativisha, Indian Atis, Atis, Atees or Aconitum heterophyllum is found in Himalayan region. It is known as Ativisha, Aruna, Shuklakanda, Bhangura, Ghunavallabha, Ghunapriya, Kaashmira, Vira, Visha, and Shishubhaishajya in Ayurveda. Atees or Aconitum heterophyllum occurs in the alpine Himalayas of Sikkim, Nepal and adjoining parts of southern Tibet also from Kashmir to the Kumaun hills at altitudes of 2500-3900 meters. The root and tuber of plant are used in internal prescriptions for fevers, rheumatic conditions and for loss of vitality. The roots are astringent and used in diarrhoea, especially in infants, and in dyspepsia, vomiting, cough, irritability of the stomach and colic. Aconitum heterophyllum root is bitter in taste. It has expectorant, febrifuge, anthelmintic, anti-diarrhoeal, anti-emetic, and anti-inflammatory properties. It is used in diarrhoea, dysentery and gastric pain. It is used as a bitter tonic to combat debility after malaria and other fevers. It is also used against hysteria, dyspepsia, vomiting and cough. Atees is used in Ayurveda for due to scorpion or snake bite. General Information of Ativisha (Aconitum heterophyllum) Plant Description: Aerial parts are annual but the roots are biennial. The stem is clasping and erect. The branches are absent or rarely one or two in number. Leaves are glabrous, sessile, and variable in shape and size. Roots: Conical, fusiform or cylindrical, about 2.0 to 7.5 cm. long and 0.4 to 1.6 cm. or more thick at its upper extremity, gradually decreasing in thickness towards tapering end, externally yellowish to greyish white, external surface wrinkled marked with scars of fallen rootlet and with a rosette of scaly rudimentary leaves on top. Fracture short, starchy, white, fractured surface marked towards center by 4 to 7 concentrically arranged yellowish-brown dots, corresponding to end of fibrovascular bundles. Taste is bitter with no tingling sensation and odourless. Aconitum heterophyllum is classified into white, yellow, red, and black varieties. The white tuber variety, with rapid growth and high yield, is considered to be the best. Flowers: Large, hooded, white–violet in colour and occur in slender racemes or lax leafy panicles. Corolla is hairy. Carpels are five in number, containing 10–18 follicles. Flowering and fruiting occur from August to October in the third year of growth.Part(s) used for medicinal purpose: Dried tuberous rootsPlant type / Growth Habit: HerbDuration: biennial herbDistribution: The species is found in grassy slopes of alpine Himalayan region, between 3000 m and 4200 m altitude, sometimes descending up to 2200 m.Habitat: Sub-alpine and alpine climate.Propagation: Seeds, tuber segments or young leafy stems can be used. Vernacular names / Synonyms of Ativisha Scientific name: Aconitum heterophyllumAssamese: AatichAyurvedic: AtivishaBengali: AtaichaEnglish: Atis rootGujrati: Ativishni Kali, Ativikhani KaliHindi: AtisKannada: Ativisha, AthihageMalayalam: Atividayam, AtivitayamMarathi: AtvishaOriya: AtushiPunjabi: Atisa, AteesSanskrit: Ativisa, Aruna, Ghunapriya, VisaSiddha: AthividayamTamil: Atthiranam, Mathiri, PankuraiTelugu: AtivasaTrade: AtisUnani: AteesUrdu: Atees Aconitum heterophyllum Scientific Classification All plants are scientifically classified into main 7 levels. These levels are Kingdom, Division, Class, Order, Family, Genus and Species. A genus comprise of many species and botanical name consists of Genus (uppercase) followed by Species (lowercase). Genus consists of many species which are closely related and have lots of similarities. Species is the lowest level and represents the group of same plant. The botanical name of Atees is Aconitum heterophyllum. It belongs to plant family Ranunculaceae. Below is given taxonomical classification of plant. Kingdom: Plantae (comprising all living or extinct plants)Subkingdom: Tracheobionta (have lignified tissues or xylem for conducting water and minerals)Superdivision: Spermatophyta (produce seeds)Division: Magnoliophyta (flowering plants)Class: Magnoliopsida (flowering plant producing an embryo with paired cotyledons)Subclass: MagnoliidaeOrder: RanunculalesFamily: Ranunculaceae – Buttercup familyGenus: AconitumSpecies: Aconitum heterophyllum Aconitum heterophyllum (Ativisha) Constituents Aconitum heterophyllum roots Atisine, F- dihydroatisine, hetisine, heteratisine, heterophyllisine, heterophylline, heterophyllidine, hetidine, hetisinone and atisenol. Aconitum heterophyllum Ayurvedic Properties and Action Aconitum heterophyllum is known as Ativisha, Sitashringi, Bhangura or Pankura, Upavishaaka in Sanskrit. In Charak Samhita it has been recommended for treating obesity, piles, stomach disorders etc. In Sushruta Samhita it was suggested as a remedy against diarrhea. Aconitum heterophyllum is considered bitter and pungent in taste (Rasa), pungent after digestion (Vipaka), and is hot in effect (Virya). It is an Ushna Virya herb. It is considered bad for sperms and fetus. It has property of digestion, vomiting and purging, and gives feeling of lightness. Rasa (taste on tongue): Katu (Pungent), Tikta (Bitter)Guna (Pharmacological Action): Laghu (Light), Ruksha (Dry)Virya (Action): Ushna (Heating)Vipaka (transformed state after digestion): Katu (Pungent) Ayurvedic Actions / Karma of Ativisha Ama nashak: toxin digesterAtisaraghna: Controls Doarrhoea.Deepana: Promote appetite but do not aid in digesting undigested food.Grahi: Inspissants; stomachic, digestive and heating qualities dry the fluids of the body.Jwarahara: Decreases vega of jwara and reduces the burning sensation.Kasahara: Removes cough.Krimighna: Destroys worms.Pachana: Digests Ama but does not increase appetite.Raktadoshahar: blood purifying.Vishahara: Destroyer of poisonCyperus rotundus, can be used as substitute of Aconitum heterophyllum. If ativisa is not available, then in its place Musta should be used. Important Formulations of Ativisha Lodhrasava, Shiva Gutika, Lakshminarayana Rasa, MahaVishagarbha Taila, Rasnairandadi KvathaChurna, Sudarshana Churna, Panchatikta Guggulu, Balachaturbhadrika Churna THERAPEUTIC USES Of Ativisha Jvara, Kasa, Chardi, Amatisara, Krimiroga Important Medicinal Properties of Ativisha Aconitum heterophyllum is rich in medicinal properties. The understanding of these properties will help us to better utilize this herb. These also indicate the conditions in which we should avoid it. Below is given medicinal properties along with the meaning. Antidote: Counteracts a poison.Anti-dysenteric: Relieving or preventing dysentery.Anti-inflammatory: Reducing inflammation by acting on body mechanisms.Antioxidant: Neutralize the oxidant effect of free radicals and other substances.Antipyretic/antifebrile/febrifuge:Effective against fever.Aphrodisiac: Stimulates sexual desire.Bitter tonic: Tonic of bitter taste, acts chiefly by stimulating the appetite and improving digestion.Carminative: Preventing the formation or causing the expulsion of flatulence.Hemostatic: Checking blood flow.Hemostatic: Checking blood flow.Hepatoprotective: Prevent damage to the liver.Hepatoprotective: Prevent damage to the liver. Ativisha (Aconitum heterophyllum) Medicinal Uses Aconitum heterophyllum is regarded as nonpoisonous, antiperiodic, anti-inflammatory and astringent. It is used in cough, diarrhea, dyspepsia, as a tonic after fevers, febrifuge, antispasmodic. The roots are bitter tonic, stomachic, digestive, alleviates dysentery and bilious complaints. It helps in periodic and intermittent fevers as a tonic, dyspepsia and cough. It is Non-poisonous plant and used in a variety of traditional medicines. Constipation An equal quantity of powders Atis root Aconitum heterophyllum), Vach (rhizome of sweet flag), Haritaki (fruit rind of chebulic myrobalan), Chitrak (root of leadwort/Plumbago zeylanica), Yavakshara (salt of potassium and sodium), Pippli (Piper longum) fruit, and rhizome of costus (Saussurea lappa) is mixed. This is taken twice/day with warm water at a dose of 3 to 6 g. Mumps, Parotitis Decoction of equal part of roots of Asvagandha (Withania somnifera Linn.), Musli, Atibala (Sida rhombifolia Linn.), Ativisa (Aconitum heterophyllum Wall) and stem of Guduchi (Tinospora cordifolia) in dose of 14 to 28 ml, is given three times a day. Fever Pulverized Aconitum heterophyllum, (6 Ratis), may be administered three or four times, at intervals of two or three hours. Digestion improvement The decoctions of dry ginger, Cyperus rotundus, Aconitum heterophyllum, and Tinospora cordifolium mixed together, digest all faults of indigested food, and excite the power of digestion. Diabetes, leucorrhoea, as carminative Aconitum heterophyllum root mixed with Ajuga parviflora leaves and Podophyllum hexandrum roots are dried in shade and powdered. The powder is given half teaspoonful twice a day early in the morning and at night after meals up to three months for the treatment of diabetes, leucorrhoea and as carminative. Chronic fever, diarrhea The aqueous extract of the root 5-10 ml is given twice a day, early in morning empty stomach and at night after meals for 7 to 28 days in chronic fever, in diarrhea and as cold efficacy. Loose motions with mucus A mixture of equal parts of Triphala, Cyperus scariosus and Aconitum heterophyllum is taken in Dose 3 g twice daily. Fevers, loose motions, gastroenteritis, vomiting, coughs, colds Make a fine powder of 50 g each of Pippali, Cyperus scariosus, Aconitum heterophyllum and Pistacia lentiscus gall. Give in dose of 1 gram with honey. Aconitum heterophyllum Ativisha Dosage The recommended dosage is 500 mg to 1 gram. Contraindications, Interactions, Side-effects and Warnings Some of the species of genus Aconitum, Aconitum ferox and Aconitum spicatum are deadly poisonous due to alkaloid aconitine. However, among the reported ~250 species of Aconitum, A. heterophyllum is the only non-toxic species with therapeutic potential. The pharmacological properties of Aconitum heterophyllum are attributed to the non-toxic active constituents i.e. aconites, including atisine comprise the major alkaloid constituents of this plant species. It was found that while atisine has a hypotensive effect at every tested dose, the plant extract as a whole showed hypertensive property. Hypertension produced by high doses of aqueous extract was attributed to the excitement of the sympathetic nervous system. Aconitum heterophyllum is a nonpoisonous. It does not contain the toxic aconitine group of alkaloids and is safe even for infants, to whom it is often prescribed as an antidote to poisons. It may cause dryness in body.Its heavy dose has narcotic effect.Aconitum heterophyllum has the ability to make the sympathetic nervous system more sensitive to physiological stimuli.Like other Aconitum species for this no purification process is mandatory.Root can be purified by boiling in milk or cow urine before use.Dr. Tapan Kumar Sau5 Likes9 Answers
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pt came in casualty, no chest pain,share your opinions,Dr. Nilesh Aswar2 Likes36 Answers
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A 78-year-old lady was admitted to hospital for dizziness. She has diabetes mellitus and mild renal impairment (creatinine level around 200 μmol/L). There was no neurological deficit and there was no chest pain. Physical examination was unremarkable but the blood pressure was only around 90/60 mmHg. An ECG was done. What does the ECG shows ? Her blood K+ level was found to be 7.8 mmol/L. What treatment may be considered ?Fayiz Moosa2 Likes23 Answers
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70y,M DM for 3yrs. Irregular in treatment, diagnosed as Hypertensive by some one 2months back & treated with TELMISARTAN 80 + HCTZ 12.5. Had developed ulcer 15days back. Came to me with disoriented condition, Nausea, vomiting. Discontnued antiHTN drug 2 days & now BP is 134/82mmHg. Investigation report shows FBS - 96, 2hrPPBS-146, Urea 40, Creatinine 1.6, Na - 115, K - 2.6, Total Cholesterol - 164, TG - 129, HDL - 34, LDL - 106, TLC 9,600, Hb - 9.6 Suggest treatment.Dr. Sandip Debashis Mishra3 Likes16 Answers
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45 yrs old male pt. No k/c/o - DM /HTN. suffring from this bilateral Erythematous lesion with itching and burning since 10 days. P/H/O taking allopathic medicine for tinea (as per patient details not availebel ) Dx and Rx.Dr. Shital Jadhav4 Likes20 Answers