What is the yellow drip in hospital?

Pneumonia

Pneumonia is swelling (inflammation) of the tissue in one or both lungs. It’s usually caused by a bacterial infection.

At the end of the breathing tubes in your lungs are clusters of tiny air sacs. If you have pneumonia, these tiny sacs become inflamed and fill up with fluid.

Symptoms of pneumonia

The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or they may come on more slowly over several days.

Common symptoms of pneumonia include:

• a cough – which may be dry, or produce thick yellow, green, brown or blood-stained mucus (phlegm)
• difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting
• rapid heartbeat
• fever
• feeling generally unwell
• sweating and shivering
• loss of appetite
• chest pain – which gets worse when breathing or coughing

Less common symptoms include:

• coughing up blood (haemoptysis)
• headaches
• fatigue
• nausea or vomiting
• wheezing
• joint and muscle pain
• feeling confused and disorientated, particularly in elderly people

When to see your GP

See your GP if you feel unwell and you have typical symptoms of pneumonia.

Seek urgent medical attention if you’re experiencing severe symptoms, such as rapid breathing, chest pain or confusion.

Who’s affected?

In the UK, pneumonia affects around 8 in 1,000 adults each year. It’s more widespread in autumn and winter.

Pneumonia can affect people of any age, but it’s more common – and can be more serious – in certain groups of people, such as the very young or the elderly.

People in these groups are more likely to need hospital treatment if they develop pneumonia.

What causes pneumonia?

Pneumonia is usually the result of a pneumococcal infection, caused by bacteria called Streptococcus pneumoniae.

Many different types of bacteria, including Haemophilus influenzae and Staphylococcus aureus, can also cause pneumonia, as well as viruses and, more rarely, fungi.

As well as bacterial pneumonia, other types include:

• viral pneumonia – most commonly caused by the respiratory syncytial virus (RSV) and sometimes influenza type A or B; viruses are a common cause of pneumonia in young children
• aspiration pneumonia – caused by breathing in vomit, a foreign object, such as a peanut, or a harmful substance, such as smoke or a chemical
• fungal pneumonia – rare in the UK and more likely to affect people with a weakened immune system
• hospital-acquired pneumonia – pneumonia that develops in hospital while being treated for another condition or having an operation; people in intensive care on breathing machines are particularly at risk of developing ventilator-associated pneumonia

Risk groups

The following groups have an increased risk of developing pneumonia:

• babies and very young children
• elderly people
• people who smoke
• people with other health conditions, such as asthma, cystic fibrosis, or a heart, kidney or liver condition
• people with a weakened immune system – for example, as a result of a recent illness, such as flu, having HIV or AIDS, having chemotherapy, or taking medication following an organ transplant

Diagnosing pneumonia

Your GP may be able to diagnose pneumonia by asking about your symptoms and examining your chest. Further tests may be needed in some cases.

Pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such as the common cold, bronchitis and asthma.

To help make a diagnosis, your GP may ask you:

• whether you feel breathless or you’re breathing faster than usual
• how long you’ve had your cough, and whether you’re coughing up mucus and what colour it is
• if the pain in your chest is worse when you breathe in or out

Your GP may also take your temperature and listen to your chest and back with a stethoscope to check for any crackling or rattling sounds.

They may also listen to your chest by tapping it. Lungs filled with fluid produce a different sound from normal healthy lungs.

If you have mild pneumonia, you probably won’t need to have a chest X-ray or any other tests.

You may need a chest X-ray or other tests, such as a sputum (mucus) test or blood tests, if your symptoms haven’t improved within 48 hours of starting treatment.

Treating pneumonia

Mild pneumonia can usually be treated at home by:

• getting plenty of rest
• taking antibiotics
• drinking plenty of fluids

If you don’t have any other health problems, you should respond well to treatment and soon recover, although your cough may last for some time.

As pneumonia isn’t usually passed from one person to another, it’s safe to be around others, including family members.

However, people with a weakened immune system should avoid close contact with a person with pneumonia until they start to get better.

For at-risk groups, pneumonia can be severe and may need to be treated in hospital.

This is because it can lead to serious complications, which in some cases can be fatal, depending on a person’s health and age.

Complications of pneumonia

Complications of pneumonia are more common in young children, the elderly and those with pre-existing health conditions, such as diabetes.

Possible complications of pneumonia include:

• pleurisy – where the thin linings between your lungs and ribcage (pleura) become inflamed, which can lead to respiratory failure
• a lung abscess – a rare complication that’s mostly seen in people with a serious pre-existing illness or a history of severe alcohol misuse
• blood poisoning (septicaemia) – also a rare but serious complication

You’ll be admitted to hospital for treatment if you develop one of these complications.

Preventing pneumonia

Although most cases of pneumonia are bacterial and aren’t passed on from one person to another, ensuring good standards of hygiene will help prevent germs spreading.

For example, you should:

• cover your mouth and nose with a handkerchief or tissue when you cough or sneeze
• throw away used tissues immediately – germs can live for several hours after they leave your nose or mouth
• wash your hands regularly to avoid transferring germs to other people or objects

A healthy lifestyle can also help prevent pneumonia. For example, you should avoid smoking as it damages your lungs and increases the chance of infection.

Excessive and prolonged alcohol misuse also weakens your lungs’ natural defences against infections, making you more vulnerable to pneumonia.

People at high risk of pneumonia should be offered the pneumococcal vaccine and flu vaccine.

Treating pneumonia

Mild pneumonia can usually be treated at home with rest, antibiotics and by drinking plenty of fluids. More severe cases may need hospital treatment.

Unless a healthcare professional tells you otherwise, you should always finish taking a prescribed course of antibiotics, even if you feel better.

If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic.

After starting treatment, your symptoms should steadily improve.

However, how quickly they improve will depend on how severe your pneumonia is.

As a general guide, after:

• one week – fever should have resolved
• four weeks – chest pain and mucus production should have substantially reduced
• six weeks – cough and breathlessness should have substantially reduced
• three months – most symptoms should have resolved, but you may still feel very tired (fatigue)
• six months – most people will feel back to normal

Treatment at home

Visit your GP if your symptoms don’t improve within three days of starting antibiotics.

Symptoms may not improve if:

• the bacteria causing the infection is resistant to antibiotics – your GP may prescribe a different antibiotic, or they may prescribe a second antibiotic for you to take with the first one
• a virus is causing the infection, rather than bacteria – antibiotics have no effect on viruses, and your body’s immune system will have to fight the viral infection by creating antibodies

Painkillers, such as paracetamol or ibuprofen, may help relieve pain and reduce fever.

However, you shouldn’t take ibuprofen if you:

• are allergic to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
• have asthma, kidney disease, a history of stomach ulcers or indigestion

Cough medicines aren’t recommended as there’s also little evidence they are effective. A warm honey and lemon drink can help relieve discomfort caused by coughing.

Your cough may persist for two to three weeks after you finish your course of antibiotics, and you may feel tired for even longer as your body continues to recover.

Drink plenty of fluids to avoid dehydration, and get plenty of rest to help your body recover.

If you smoke, it’s more important than ever to stop, as smoking damages your lungs.

See your GP if, after following the above self-help measures, your condition is deteriorating or isn’t improving as expected.

Pneumonia isn’t usually passed from one person to another, so it’s safe to be around others, including family members.

However, it’s best for people with a weakened immune system to avoid close contact with a person with pneumonia until they start to get better.

Follow-up

Your GP will probably arrange a follow-up appointment for you about six weeks after you start your course of antibiotics.

In some cases, they may arrange follow-up tests, such as a chest X-ray, if:

• your symptoms haven’t improved
• your symptoms have come back
• you smoke
• you’re over the age of 50

Some people may be advised to have a flu vaccination or pneumococcal vaccination after recovering from pneumonia.

Treatment in hospital

You may need treatment in hospital if your symptoms are severe. You’ll be given antibiotics and fluids intravenously through a drip, and you may need oxygen to help breathing.

In very serious cases of pneumonia, breathing assistance through a ventilator in an intensive care unit (ICU) may be required.

Banana bag

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A banana bag (or rally pack) is a bag of IV fluids containing vitamins and minerals. The bags typically contain thiamine, folic acid, and magnesium sulfate, and are usually used to correct nutritional deficiencies or chemical imbalances in the human body. The solution has a yellow color, hence the term «banana bag». [1]

Composition [ edit ]

The typical composition of a banana bag is 1 liter of normal saline (sodium chloride 0.9%) with: [2]

• Thiamine 100 mg
• Folic acid 1 mg
• Multivitamin for infusion (MVI), 1 ampule
• Magnesium sulfate 3 g

The solution is typically infused over four to eight hours or as per physician’s orders. [ citation needed ] The yellow color comes from the riboflavin in the MVI and the folic acid. [2] (The conventional composition is not optimal based on current evidence; see the Flannery et al. (2016) citation. [2] )

Uses [ edit ]

Banana bags are often prescribed for alcoholics. Chronic alcoholism can lead to significant lack of thiamine, potentially causing Wernicke–Korsakoff syndrome. Chronic alcoholics can also suffer significant whole-body magnesium deficiencies. [1] [3] However, recent evidence (2016) points that the amount of thiamine in a conventional banana bag is inadequate for prophylaxis and treatment for ICU patients. The proposed regimen is 200–500 mg IV thiamine every eight hours for the first day of admission. Less evidence exists for the use of magnesium and folic acid, for which a less radical change in dosage is proposed. No evidence for the use of multi-vitamins are found for alcoholics. [2] Vitamin C is proposed to be added based on the prevalence of low blood levels among alcoholics, but its therapeutic usefulness is undefined. [4]

Banana bags [ citation needed ] are used in the intensive care unit to correct acute magnesium deficiencies, a common occurrence in the ICU. Magnesium is stated to be beneficial for patients with terminal illness because deficiency can cause nerve pain and muscle cramps. [5]

Banana bags (more narrowly, thiamine) are under-used when alcoholics present to the hospital with illnesses other than alcohol withdrawal, especially for critical illnesses such as sepsis, traumatic brain injury, and diabetic ketoacidosis. [6] Using thiamine on septic alcoholics seems to reduce the rate of death. [7]

See also [ edit ]

• Intravenous therapy

References [ edit ]

1. ^ ab Jeffrey E Kelsey; D Jeffrey Newport & Charles B Nemeroff (2006). «Alcohol Use Disorders». Principles of Psychopharmacology for Mental Health Professionals. Wiley-Interscience. pp. 196–197. ISBN978-0-471-79462-2 .
2. ^ abcd
3. Flannery, Alexander; Adkins, David; Cook, Aaron (2016). «Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU» (PDF) . Critical Care Medicine. 44 (8): 1545–1552. doi:10.1097/CCM.0000000000001659. PMID27002274. S2CID22431890.
4. ^
5. Merle A. Carter & Edward Bernstein (2005). «Acute and Chronic Alcohol Intoxication». In Elizabeth Mitchell & Ron Medzon (eds.). Introduction to Emergency Medicine. Lippincott Williams & Wilkins. p. 272. ISBN978-0-7817-3200-0 .
6. ^
7. Marik, PE; Liggett, A (10 May 2019). «Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders». Critical Care. 23 (1): 165. doi:10.1186/s13054-019-2435-4. PMC6511125 . PMID31077227.
8. ^
9. Panahi, Y; Mojtahedzadeh, M; Najafi, A; Ghaini, MR; Abdollahi, M; Sharifzadeh, M; Ahmadi, A; Rajaee, SM; Sahebkar, A (2017). «The role of magnesium sulfate in the intensive care unit». EXCLI Journal. 16: 464–482. doi:10.17179/excli2017-182. PMC5491924 . PMID28694751.
10. ^
11. Pawar, RD; Balaji, L; Grossestreuer, AV; Thompson, G; Holmberg, MJ; Issa, MS; Patel, PV; Kronen, R; Berg, KM; Moskowitz, A; Donnino, MW (February 2022). «Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study». Annals of Internal Medicine. 175 (2): 191–197. doi:10.7326/M21-2103. PMC9169677 . PMID34871057.
12. ^
13. Hu, C; Wu, T; Ma, S; Huang, W; Xu, Q; Kashani, KB; Hu, B; Li, J (April 2022). «Association of Thiamine Use with Outcomes in Patients with Sepsis and Alcohol Use Disorder: An Analysis of the MIMIC-III Database». Infectious Diseases and Therapy. 11 (2): 771–786. doi:10.1007/s40121-022-00603-1. PMC8960538 . PMID35169996.

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IV Fluids

IV fluids are specially formulated liquids that are injected into a vein to prevent or treat dehydration. They are used in people of all ages who are sick, injured, dehydrated from exercise or heat, or undergoing surgery. Intravenous rehydration is a simple, safe and common procedure with a low risk of complications.

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Overview

What are IV fluids?

IV fluids are liquids injected into a person’s veins through an IV (intravenous) tube. They prevent or treat dehydration and electrolyte imbalances.

Why are intravenous fluids used?

Water is essential to every cell in our bodies. In fact, our bodies are made up of about 60% water. When you don’t have enough water in your body, that’s called dehydration. A person needs IV fluids when they become dangerously dehydrated.

Serious dehydration may occur when you:

• Are sick (vomiting and diarrhea).
• Exercise too much or spend too much time in the heat without drinking enough.
• Have a serious injury or burns.
• Have surgery, especially when you’re asleep for a long time or are unable to eat or drink.

What are the effects of dehydration?

When you are dehydrated, it can affect:

• Balance of important minerals (electrolytes) in the body.
• Cognitive (mental) performance.
• Energy level.
• Gastrointestinal function (your ability to digest food and create pee and poop).
• Headache frequency and intensity.
• Many organs, including the kidneys, heart and brain.
• Physical performance.
• Skin health.

Signs of severe dehydration include:

• Dizziness.
• Dry eyes (no tears).
• Dry lips and tongue.
• Dry, wrinkly or blotchy skin.
• Fatigue (feeling tired).
• Fast breathing.
• Hands and feet that are cool to the touch or blotchy looking.
• Less pee than usual (fewer than four times per day).
• Pee that is dark yellow and smells strong.

Procedure Details

What are the types of IV fluids?

There are different kinds of IV fluids. Your healthcare provider will decide which type is right for you, depending on why you need them.

Crystalloid solutions: These are the most common types of IV fluid. They contain small dissolved molecules that pass easily from the bloodstream into tissues and cells. Examples include normal saline, which is salt in water, and D5W, which is dextrose (sugar) in water. Another example is lactated Ringer’s, which contains sodium, chloride, potassium, calcium and lactate. It’s used for aggressive fluid replacement.

Colloids: These are large molecules that can’t easily pass through cell membranes and are more likely to stay in the blood vessels. Examples include albumin and hetastarch.

What happens during rehydration with IV fluids?

If you need IV fluids, a healthcare provider will:

• Decide the type of IV fluid you need.
• Determine the amount of fluid you need and how quickly. This is based on many factors, including your weight, age and medical conditions.
• Disinfect (clean) the skin where the IV will go, usually on the inside of the elbow or on top of the hand.
• Tie an elastic band (tourniquet) around your arm to make blood fill the veins.
• Examine the veins to find the exact insertion site.
• Slide a sterile needle into the vein, which may pinch. The needle will have a small plastic tube at the other end.
• Remove the tourniquet.
• Place a small plastic attachment onto the tube.
• Test the tube to make sure a little bit of fluid can go in.
• Tape the IV needle to your arm so that it stays in place.
• Attach the small tube to a longer tube, and then attach it to a bag of fluids.
• Hang the bag from a hook on a tall stand (called an IV stand).
• Turn on a machine that will pump the fluid into the IV line.
• Check your IV line regularly and monitor the amount of fluid entering your body.

The IV also may be used to deliver medications or nutrition.

What happens after IV fluids?

IV fluids can make you feel better very quickly. But your healthcare providers will determine when you can stop receiving intravenous fluids.

Risks / Benefits

What are the advantages and risks of this procedure?

IV rehydration is a common, simple and safe procedure that can make you feel better quickly and help save your life if you are seriously ill.

But rare complications can occur, including:

• Air embolism: An air embolism, or gas embolism, occurs when an IV pushes too much air into the vein. It’s rare but can have serious consequences, including possible death.
• Collapsed vein: Sometimes, the vein collapses when the needle is inserted or when an IV is in place for a long period of time. If this happens, your healthcare provider will try to find another vein to use. There are many other veins to take over for the collapsed vein.
• Fluid overload: If too much fluid is given too quickly, you can experience headache, high blood pressure and trouble breathing. This usually resolves quickly with an adjustment to fluid levels. But it can be dangerous.
• Hematoma: A hematoma occurs when blood leaks from the blood vessel into nearby tissues. It looks like a bad bruise and usually goes away in a few weeks.
• Infection: If the area is not clean when the needle is inserted, infection may occur. Your healthcare provider can usually treat infections with antibiotics.
• Infiltration: If the needle moves or gets dislodged, fluids can enter tissues around the vein. This may cause stinging and bruising, but it’s typically easy to resolve.
• Phlebitis: Phlebitis occurs when the vein becomes swollen because of the IV. It’s one of the more common complications, but it’s usually easily treatable by removing the IV, applying a warm compress and elevating the arm.

Recovery and Outlook

What is the recovery time after receiving IV fluids?

Many people don’t need recovery time or have any restrictions after receiving IV fluids.

However, you may need other treatments or additional rest depending on the reason you needed rehydration in the first place. For example, if you had vomiting or diarrhea due to infection, you might need to take medicines afterward. If you had surgery, you might have certain restrictions while you heal.

Ask your healthcare provider about your recovery and restrictions.

When to Call the Doctor

When should I report something to my healthcare provider while receiving IV fluids?

Tell your healthcare provider if the IV fluids seem to be flowing too slowly or too quickly.

Also, tell the physician or nurse if you have any discomfort at the IV site, a loose IV needle, headache or trouble breathing.

A note from Cleveland Clinic

IV fluids are specially formulated liquids that are injected into a vein to prevent or treat dehydration. Intravenous rehydration is a simple and safe procedure used in people who are sick, injured, dehydrated from exercise or heat, or undergoing surgery.