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IV Therapy (week 3)

this is the first time she's been here for lecture, we've had two other lecturers
Dr Szabat teaches a lab dx review class, date not set but it's on offer this summer

Dr S got into naturopathy dt interest in herbs and body/mind/spirit
took philosophy from Jarred Zeff but still felt spirit wasn't fully addressed
6 yrs after graduating looked again at her quest for spirit
went to a body mind spirit expo (I went to one of these, it really was a mind opener)
"we are more than these little containers of blood flesh and bone"
she's going to begin offering more esoteric services in her private practice
the modern mystery school, life activation, better communications
this work has been transformative and empowering for her personally
she used to be afraid to talk on the telephone and now leaves soliloquy voice messages
she offers her assistance if we are interested
max meditation tm is another modality she has espoused

she's not big on powerpoint and won't be converting her notes
her mind works in flow sheet fashion, algorithmic, her mind maps don't fit on power point slides
when she used to teach lab dx she had been a med tech for years
she's not big on technology, getting screens on

today will talk on IV solutions and into the realm of mathematics
she's an expert phlebotomist but starting an IV is more involved than a draw
open to learning from those among us who have experience

osmolarity calculations due weekly in lab
and flow rate calculations

focusing on vitamins and minerals in this class
not looking at HCl to irritate WBCS and stim immune sys
not on herbals ie glycyrrhizic acid as anti-inflam

Book: Parenteral Micronutrient Therapy on reserve in library

Handout title: IV Solutions
solvent is water, plasma in humans, serum after cells and clotting factors are out
osmolarity, osmolality, sometimes used interchangeably but units slightly different
1.010 osmol of plasma, water is 1.000
no need to memorize formula
hyperosmolar solution will pull water from tissues
hypoosmolar will drive it into tissues from vasculature
isotonic means solution same osmol as serum
serum osmol = 280-295 mOsm/L
*broad range for isotonic solution is 250-375 mOsm/L, won't cause sig fluid shifts
*hypotonic = under 250
imp in CHF, don't want to overload heart or kidneys
she won't give IV until she's seen a CMP
for allergic rxns clinic has epi pens, not sufficient for her taste
indications for IV: malnutrit, malabsorb, cachexia,
42 liters of water in a human includes intravasc, intracell, and extracell

she gives cancer pts high vit C doses
osmol of final solution over 1000, mb v irritating to bv lining
so she puts it in big vein, superior vena cava via a pick line or an implanted port

*can't put hypoosmolar fluids in without causing hemolysis of RBCs
test: put a drop of blood in water and watch it disappear as the cells pop
making iv solution in sterile water
standard size 500ml, formula calls for 400ml, consider that tubes contain just sterile water
must prime tube to get water out, avoid giving hypotonic solution
avoid hemolytic transfusion rxn

her bloodtype is B
if given type A blood her Abs would pop all the RBCs
causing strain on kidneys
that's how transfusion fatalities kill

isotonic expansion
add more fluid

hypertonic expansion
add more fluid and shift fluid out of cells

her iv therapy shift
we're invited to come, participate, learn
solutions not too acidic, ??7.33??-7.45 range? not sure I heard that right
*look this up

showing sample bottle
dexapanthenol 250mg/mL
for iv or intraocular use
lot number imp, ck exp date
write date on bottle when you open new bottle
can only use within 30 days of opening

table of osmolarities of solutions used here
two suppliers: merit and *Mcguff, that's the one she uses
pay close attention to Magnesium vs Manganese, don't mix up!

digression
Dr S was very ill last month
back out, bronchitis, sinusitis
didn't update all procedure forms re: how vit C is made
FDA dropping hammer on iv nutrients
can't infuse vit C made at regular pharm co in mass production process
can infuse if made by compounding pharmacist
"it's semantics, legal mumbo jumbo"
eventually you'll have to get a prescription to get oral vitamin c, Europe leading the way

handout: osmolarity computation
formulas from Dr Osborne still in use
four nutrients in sample formula are contributing osmolarity
vol x mOsm/ml = mOsm for that nutrient, add these up and also total the volumes
final osmol of solution is total mOsm over total volume with volume converted to liters
*5.80 is mOsm for vit C, it was 5.94 before FDA action and tables for class are incorrect*
*bring calculator to class!!!

last thing for the day
look on syllabus, there's a quiz next week
on the reading material for week 4
MUST READ
*know complications
quiz is learning tool only, not part of grade

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