The tropics where even IV fluids grow on trees.

Coconut water with a bit of lime, and rum, medicinal use only, is okay but it's generally taken orally as a libation.

But what if you need IV fluids? According to this you can tap the coconuts:

Where I read about it recently:
http://www.straightdope.com/columns/read/2925/can-coconut-juice-be-used-as-blood-plasma-plus

An interesting PDF that gives detail information:
http://pinky.ratman.org/~drolley/PDF/inject%20some%20coconut.pdf

Mentioned in:
http://www.docstoc.com/docs/25580924/Discussion-of-IV-Fluids

There are other references in the professional literature but, unfortunately, you need the subscribe or but each paper individually. It gets pricey to casually explore a subject.

So what do everyone think? I don't think coconut water would be my first choice of IV fluid. I would lean toward the plastic bags with the fancy labels as long as they last. But given a lack of other options, and a patient that will surely die otherwise, I might give it a go. Not everyone will, or needs to, see it that way. Discuss.

If you really need a "home made" blood volume expander, stick with sterilized sea water. The sodium chloride concentration is roughly equivilant to isotonic (normal) saline, i.e. 0.9%.

Please note I am not a medical doctor. I do know that other IV fluids such as dextram, non-normal saline etc. may cause problems depending on patient condition.

Do you have a reference for seawater being near isotonic? Everything I have read indicates seawater is significantly hypertonic (approx. 2.5%).

Pete

Seawater is significantly hypertonic.

They did that in WWII, using coconut as IV fluid.

After reading these links, looks like coconut water has been used with some success. I drink it myself as a cold beverage from time to time. Easily found at my local health food stores. Good source of electrolytes and potable water.

Hmmm, I wonder what the risk of infection from those cartons of coconut water would be if used as an IV straight from the box? I believe they are pasteurized. I know, that's not the same thing as saying something is "sterile" but we're talking worst case scenario here.

However, sounds like a rather odd situation to be--had the equipment to administer an IV but only coconut water available? Sounds like wartime, like maybe a Sarajevo scenario.

Another way to get this into your system might be the good ol' enema. Slower but safer than injecting it directly, if utmost speed isn't critical.

Pasteurized is safe to drink but not something I'd pump into my blood stream, bacteria is only inactivated but a small percent is still alive.

It is sterile while inside the coconut thou.

I understand that Bear uses a coconut milk enema to replenish fluids...I'm not sure if he removes the milk from the coconut first, or not ;-)

Saline is sodium chloride in water, if it has glucose or any other additives it is no longer plain saline. You can get D5NS which is Dextrose 5% in Normal Saline (0.9% sodium chloride). Lots of different IV solutions out there which are indicated or contraindicated for some conditions/situations.

Sea/ocean water is significantly hypertonic, averaging 3.5%. Hypertonic saline has been used for treatment of patients in shock due to significant blood loss but I would not use it for dehydration and would look for a source of plain water. Hypertonic saline causes a shift of fluid from cellular and intracellular space to the circulatory system which is not desirable in dehydrated patients.

A way to get fluids into patients that can not tolerate fluids by mouth is rectally. Yes this is not an ideal means but is an option. Ideally you would have some delivery device such as tubing and a reservoir. The rectum is highly vascular and allows for rather quick absorption of medications and fluid. Not quite as fast as IV but faster than some other routes. Here is a short article on the use and success of rectal fluids, also referred to as proctoclysis: http://www.ncbi.nlm.nih.gov/pubmed/9601155

ETA: I would much quicker to put fluid that wasnt sterilized and purified in a lab type environment in the rectum vs. a vein. The rectum is more accustomed to dealing with bacteria moving through it than the circulatory system.

If the situation calls for IV and the ONLY recourse is coconut water....you have more to worry about than infection. Assuming you have the tubing to administer IV's, you probably have any left over bags (even if empty). Sterilizing H2O and administering is still infection risky...you need to 'refill' the bag-plenty of routes for infection. 20 something years in EMS....don't think I'd ever see a reason to 'use' coconut water. If it gets that bad....there is more to worry about than IV replenishment.

CJK
Yes and no. I'm sure you're thinking from an EMS perspective, ie volume from trauma.

But I could see that, living in the tropics, you're exposed to all sorts of parasites. So something like dysentery, this could be good - you're going to be pouring fluids out with diarrhea and this might keep you going.

But, yes, infections will be a concern. Even with a regular IV.

Quote from Wikipedia



So, as Pete and others have mentioned, it is different from saline, unless you dilute it 3-4 times. However, there are other problems with seawater. It has a lot of microscopic critters that you don't want in your blood stream. Anything from algae to bacteria.

So, if it was a matter of life and death you filter it through 0.2 micron filter , BOIL IT, and then dilute it 4 times with distilled or drinking water. Only then ....

I watched part of an interesting lecture on video the other day. A reserve (or maybe NG) surgeon was talking about a revised treatment plan the military has started using on wounded soldiers with severe blood loss. He is calling it hemostatic resuscitation.

No Ringers or other IV fluids containing crystalloids (whatever that is) are used because it causes swelling.

Mostly they are using packed red blood cells, whole blood, and hypertonic saline. Also something called R factor VII which seems to cost a bunch of money but apparently promotes clotting directly at the wound site(s).

I gather they have started using the same protocol in LA with good results.

Yup. They've found that using lots of saline or Lactate Ringer's actually decreases clotting, and that large volumes may worsen outcomes. The military is going back towards blood products, at very low ratios (ie, 1 unit of red cells with 1 unit of platelets with one unit of plasma). Another reason to donate...

Recombinant Factor VII is pricey as heck. Like, $10,000/dose, and multiple doses needed. That price is probably low, too.