Intravenous fluid therapy
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This page is for adult patients. For pediatric patients, see: Intravenous fluid therapy (peds) or critical care quick reference for bolus doses by weight.
Background
Composition of Different Intravenous Fluids
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
- Of which, 2/3 is intracellular and 1/3 extracellular
Acute Repletion (Bolus)
Adult
Pediatric
See critical care quick reference for drug doses by weight.
Maintenance Fluids
Adult
- 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)
- Hourly rate daily volume/24 hr
- Calculation 1
- 100 cc/kg/d (4cc/kg/h) 1st 10 kg
- 50 cc/kg/d (2cc/kg/h) 2nd 10 kg
- 20 cc/kg/d (1cc/kg/h) each kg > 20
- Calculation 2
- 1500 cc/m2/d (bsa (m2) = sqr rt [wt (kg) x ht (cm)]/3600
Pediatric
- Maintenance fluid default: D5-LR + 20meq/L of KCl or other isotonic solution
- Isotonic fluids are now preferred (2019 AAP update)[2]
4-2-1 Rule
Rule
- mL/hr =
- (4 x first 10kg) +
- (2 x second 10kg) +
- (1 x every 1kg after)
- Example: For a 34 kg infant, you should run the IVF at 74 mL/hr. Often people choose to round to multiples of 5.
Alternative Method
Weight (kg) |
Fluid Rate |
Example |
<10 |
4 mL/kg per hour |
8 kg infant: 4mL/kg per hour x 8 kg |
10 to 20 |
40 mL/h + 2 mL/kg per hour per each add kg |
15 kg child: 40 mL/h + 2 mL/kg per hour x 5 kg |
>20 |
60 mL/h + 1 mL/kg per hour per each add kg |
30 kg child: 60 mL/h + 1 mL/kg per hour x 10 kg |
Quick Reference (Peds)
Age | Weight (kg) | IVF (mL/hr) |
Premature | 2 | 8 |
Newborn | 3.5 | 14 |
2mo | 5 | 20 |
4mo | 6.5 | 26 |
6mo | 8 | 32 |
8mo | 9 | 36 |
12mo | 10 | 40 |
15mo | 11 | 42 |
2yr | 13 | 46 |
3yr | 15 | 50 |
5yr | 19 | 58 |
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
- Normal saline (NS) = 154 mEq Na/L, 1/2 NS = 77 mEq/L, 1/4NS = 38 mEq/L
See Also
External Links
References
- ↑ Paucis Verbis: Composition of intravenous fluids. http://www.aliem.com/paucis-verbis-composition-of-intravenous-fluids/ Published January 3, 2013. Accessed August 29, 2015
- ↑ Leonard G. Feld, Daniel R. Neuspiel, Byron A. Foster, Michael G. Leu, Matthew D. Garber, Kelly Austin, Rajit K. Basu, Edward E. Conway, James J. Fehr, Clare Hawkins, Ron L. Kaplan, Echo V. Rowe, Muhammad Waseem, Michael L. Moritz, SUBCOMMITTEE ON FLUID AND ELECTROLYTE THERAPY; Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics December 2018; 142 (6): e20183083. 10.1542/peds.2018-3083