IV Fluid Maintenance and Therapy

Patient loses 2.5L/ day for a 70kg patient. This is the fluid requirements per day.

Finding out how much electrolytes (Na, K+, dextrose water) needed in that 2.5:

70kg patient normally requires 70-140mMol of Na per day

1L bag of saline solution has 154 mMol of sodium (this is normal saline)

500ml bag (most commonly used) has 77 mMol of Na

Min bags of normal saline you can give for this patient is 1, max bags is 2.

We’d just give this patient 1 bag of normal saline (500ml). They still need 2L more for the day. We give
the remaining bags as 5% dextrose water

-4 bags (2L) of 5% dextrose water

So the total for the day would be 5 bags (2.5L), of which 1 bag is normal saline, and 4 bags would be
dextrose water.
Maintenance—normal saline, potassium, 5% dextrose water

Any additional amount of fluid needed is given to patient as 5% dextrose water.

So if you gave the pt 2 bags of saline (1L), they still need 1.5L more

0.5-1ml per/kg

35ml-70ml for a 70kg person

The order in which they are given is not too important, but one tries to split them out evenly.

Need a separate standard for K+ due to arrythmia risks.

No more than 20meq of K+ given at any time (too much, or too fast, can give pt cardiac arrest)

So we divide those 35 ml into 20ml and 15ml. And we don’t give the K+ concurrently (consecutively); we
put them into alternate bags

So if they add 20 meq to the first bag with saline, they add none to the next bag of saline. But will add
the other 15meq of k+ into the third bag.

Potassium normally started on Day 2 on surgery. Due to trauma to tissues after surgery, K+ levels are
normally high already; don’t want to give more K+ on top of that and possibly give the patient
arrythmia. Some books say after Day 3, at UWIH and KPH they use Day 2.
E.g: 80kg pt, 2 days post-op, normal urea and electrolytes. Work out the maintenance fluid, na+
requirements, K+ requirements, and the dextrose water

Maintenance dose: 2700 (1500ml for the first 20kg, and 20ml/kg on the remaining kg which is 60k; total
is 2700ml)

Sodium requirement: At most 2 bags

How many bags of dextrose—4 bags (rounded); don’t round up unless told to in exam.

80 meq of Na+ 1 bag

To 150meq Na+ 2 bags

Remainder (3 bags) as dextrose water.

0.5meq of K+ per kg 40ml; (we don’t put the glucose with the potassium as it can cause precipitation;
we put the K+ in the normal saline bag; bag can look milky white due to precipitation)

40ml would be split into two bags (20ml each). We can put all the 40ml in one bag, but it requires an
infusion pump that can set the rate for the day and the pt. can’t increase the amount. Since we don’t
have that equipment on the wards, we don’t use more than 20ml per bag, and we don’t run the bags
with K+ concurrently.

For this patient:

Normal saline + 20mq K+ added

5% dextrose

5% dextrose

Normal saline + 20mqK+ added

5% dextrose

If it’s 6 bags over 24 hrs, one bag would go over 4 hours (24/4)

If we start at 8AM with the first bag, it would finish at 12; the next starts at 12, would finish at 4.

We replace GI losses, volume for volume with normal saline. And for every Litre of GI losses, we give
20meq of potassium.

If there were 2L of losses, we’d give 2L of saline, and 40meq of K+

If there were 1.5L of losses, we’d give 1.5L of saline, and 30 meq of K+

100kg patient, Day 2 post-op, 2 L losses from NG tube

Maintenance: 1500ml on first 20 kg, 20ml/kg on last 801600 ml. Total 3100ml

6 bags of fluid.

100 meq of sodium – 200meq of sodium needed

Minimum 2 bags, maximum 3 bags

Give 2 bags sodium, 4 bags of dextrose. (we’d round up to 5 bags as we never want to give less than
the pt requires)

Potassium—50meq-100meq

20meq in one bag, 20meq in one bag, 10 meq in another bag.

Now to replace losses of 2L:

2L of saline (4 bags), 40meq of Potassium (20meq per L)

Now we add up everything—6 bags of normal saline, 5 bags of dextrose, and 90 meq of potassium

(4 sets of 20, one set of 10).

Try not to round down with patients; if asked to round, you’d be told to round up to the nearest number
(of bags)