for bolus doses by weight
Background
| Fluid [1] |
Osm |
Na |
Cl |
Glucose(g/L) |
pH |
Buffer |
K |
Ca |
Mg
|
| Plasma |
289 |
140 |
103 |
|
7.4 |
HCO3 22-32 |
4 |
5 |
2
|
| Normal Saline (NS) |
308 |
154 |
154 |
0 |
5.0 |
0 |
0 |
0 |
0
|
| D5NS |
560 |
154 |
154 |
50 |
|
|
0 |
0 |
0
|
| Lactated Ringers |
273 |
130 |
109 |
0 |
6.5 |
Lactate 28 |
4 |
3 |
0
|
| Plasmalyte |
295 |
140 |
98 |
0 |
5.0 |
Gluconate 23/Acetate 27 |
5 |
0 |
3
|
| D5 1/2NS |
406 |
77 |
77 |
500 |
4.5 |
0 |
0 |
0 |
0
|
| D5W |
252 |
0 |
0 |
50 |
|
|
|
|
|
| 5% Albumin |
309 |
130-160 |
130-160 |
|
6.4-7.4 |
|
<1 |
|
|
Total Body Water
- Total Body Water (TBW) = 0.6 x weight (kg)
- Of which, 2/3 is intracellular and 1/3 extracellular
- 1/4 of extracellular is vascular
Acute Repletion (Bolus)
- Typically 20-mL/kg aliquots of isotonic (e.g., NS or LR) fluid
Maintenance Fluids
- Insensible losses = 300-400 cc/m2/d
- Adult Standard: D5 0.45%NS at 75-125 mL/hr + 20meq/L of KCl
- Deficit: % dehydration x baseline weight
- Daily volume needed = maintenance + deficit - fluid already given (i.e. boluses)
- Hourly rate daily volume/24 hr
- (or correct 1/2 of deficit in first 8 hr, remainder in next 16)
Electrolytes
- Maintenance Na = 3 mEq/kg/d; K = 2 mEq/kg/d
- Deficit = [desired - measured mEq/L] x fD x wt (kg)
- fD (distribution factor) Na = 0.6, K = 0.6, Cl = 0.2-0.3, HCO3 = 0.5
- (Maintenance + deficit)/daily volume = concentration of electrolyte in fluid to be given
- 4mL/kg of H2O lost, ups Na by 1meq
See Also
Calculators
Maintenance Fluids (4-2-1 Rule)
Maintenance IV Fluids (4-2-1 Rule)
| Parameter
|
Value
|
| Patient Weight (kg)
|
|
| Maintenance Rate
|
| Hourly Rate
|
mL/hr
|
| Daily Volume
|
mL/day
|
| References
|
- Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823-832. PMID 13431307.
- 4-2-1 Rule: 4 mL/kg/hr for first 10 kg + 2 mL/kg/hr for next 10 kg + 1 mL/kg/hr for each kg above 20 kg.
|
External Links
References
