IV fluid management as an intern

See google drive notes because this isn’t everything!

Basic human needs….ya basic

- Average requirement for a healthy person
o 2.5-3.0L of fluid per day
 Roughly 25-30ml/kg/day
o K: 0.5-1.0mmol/kg/day
 70mmol for a 70kg human
o Na: 1-2mmol/kg/day
 140mmol for a 70kg human
o Glucose
 For a fasting patient – 50-100g/day
- Be careful about IV fluids to patients with
o Cardiac failure
o Renal failure
o Liver failure – always ask senior advice
o Fasting T1DM
 Seek advice from endocrine
- Review patients
o Clinically
o Biochemically – regular UECrs

Common abnormalities in patients

- Dehydration post-op
- External losses
o Sweating
o Haemorrhage
o Vomiting/diarrhea
o Stomal/NG outputs
- Internal redistribution
o Third space losses e.g. sequestration of extracellular fluid into gut with bowel
obstruction or ileus
The NBM fasting patient requires 2-3 1L bags of IV fluids
- Types
o Crystalloid
 0.9% NaCl, CSL
o Colloid
 Gelofusin, Haemacell
o Water
 5% dextrose
o Blood products
- Evidence based medicine for fluids
o Crystalloid = colloid, no risk of anaphylaxis
o Haemorrhage requires blood replacement
o Sweat, diarrhea, vomiting, NG/stomal output best replaced with crystalloids
 Add K+ if losses are high in K
o Resuscitation
 NaCl or blood
o Fasting patients
 Particularly
 Diabetics
 Hypernatraemia patients
 These patients require 5% dextrose, although don’t give dextrose as a
resuscitation fluid

NaCL
- Potential for hyperchloraemic metabolic acidosis

CSL/Hartmann’s
- Potential for potassium accumulation
o Has 5mmol/L K+ with lesser Cl-
o Also has Ca2+ and lactate, which NaCl doesn’t have

5% Dextrose
- 50g/L of glucose translates to 200 calories per litre
- Affects BSLs in diabetic patients
o Each 1L of fluid is 10% of daily energy needs
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