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Common Scenarios IV Fluid Prescription in Adults
Home | Articles | Intravenous Fluids | Common Scenarios

Common Scenarios

Last updated 3rd December 2020

Last updated on 12th November 2019 by Chris Isles.  Due for Review 12th November 2020.

Septic Shock

  1. Rx Hartmann’s or saline up to 30ml/kg as quickly as possible starting with a 500ml bolus
  2. Vasoconstrictor inotropes such as Noradrenaline also often required
  3. NB Fluids are an important part of a package of measures (the Sepsis Six) required to treat septic shock effectively

Diagnosis of Hypovolaemia in Doubt

  1. Rx bolus of 250ml Hartmann’s or saline over 5-10min (ie squeezed in) with measurement of HR, BP, Cap Refill, CVP if monitored, before and 15 min after infusion.
  2. If vital signs improve then further bolus likely to be required

Massive Blood Loss From Trauma

  1. Rx Gelaspan 30ml/kg fast until blood products arrive. Use O neg blood if delay rather than more gelofusin.
  2. Click to view Major Haemorrhage Protocol

Acute Kidney Injury Dry But Not Shocked

  1. Rx Hartmann’s or saline
  2. If clinical or biochemical evidence of dehydration the default should be 1 litre in one hour, 1 litre in 2 hours, 1 litre in 4 hours then review.
  3. Avoid Hartmann’s if serum K >6mmol/L

Cardiorenal Failure

  1. If cardiac failure predominates, Rx trial of frusemide IV with salt and water restriction recognising that worsening kidney function may be the price you pay in order to keep lungs free of fluid
  2. If renal failure predominates Rx cautious trial of fluid, recognising that peripheral oedema may be an acceptable compromise in the trade off between heart and kidneys
  3. This is usually tricky requiring senior help, optimising cardiac function and sometimes dialysis

Vomiting

  1. Rx Saline 0.9% or Hartmann’s and appropriate K supps
  2. Vomit contains mainly HCl so patients likely to be hypochloraemic. If so then this is an indication for saline as Hartmann’s doesn’t contain enough chloride

Diarrhoea

  1. Rx Hartmann’s and appropriate K supps
  2. Diarrhoea doesn’t contain chloride so risk of hyperchloraemia with saline
  3. Same advice applies for ileostomy, small bowel fistula, ileus, bowel obstruction

NB The advice given in the above scenarios is for replacement/resus fluid in addition to maintenance fluid

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