Saline 0.9% + 20mmol potassium chloride (over 8 hours). The traditional regime = “1 salty + 2 sweet”:. Fluid type should approximately matches the normal requirements for their weight in terms of water, sodium and potassium. Oral/NG-tube fluids are safer than IV because they are much less likely to cause salt or fluid overload, electrolyte abnormalities and do not require a cannula (infection risk). Only give maintenance fluids if the patient can’t drink enough. you feel you have replaced their previous losses) consider maintenance fluids For reliable fluid status your patient will need to be catheterised to guide further fluid resuscitation. A suitable response is: pulse decreased blood pressure risen or stabilised urine output risen. 500ml 0.9% saline stat) and then reassess hydration status changes Fluid resus to replace pre-existing deficits is done in stat boluses. To replace deficits, especially if the patient is unwell, use fluid challenges The quantity of fluid replacement depends on your estimate of the fluid deficit. U&E should always be taken in clinical context However, note these can be late signs in dehydration and conversely will be chronically high in patients with chronic renal failure (even when well-hydrated). Raised creatinine and urea imply dehydration, especially if acute. Input over last 24 hours? Urine output?. MAINTENANCE FLUID CALCULATOR HOW TO
Click here to learn how to examine fluid status and hydration status.Are they thirsty (an often missed indicator of hypovolaemia).Likely quantity vomited/bled/excreted? Over how long?.Decide on the approximate deficit and the cause by:.FFP, platelets, cryoprecipitate) to actively stop the bleeding rather than simply replacing the lost red cells If the patient continues to bleed, they may also need other blood products (e.g.Should be replaced with blood (packed red cells: PRBC).Should be replaced by normal maintenance fluids (e.g.Hartmann’s solution, or saline if Hartmann’s solution not available) Replace with a fluid similar to plasma (e.g.
D&V, NG aspirates, stomas, burns, pancreatitis)
fluid loss should be replaced by fluids with a similar electrolyte content to the lost fluid. Types of fluid lost and what they should be replaced with include: The type of fluid replacement depends on the type of fluid lost i.e.Ongoing losses (replace future losses as they occur) Pre-existing fluid deficit (replace STAT) The type and rate of maintenance fluids (if needed) are based on the patient’s fluid and electrolyte requirements (dependent on their weight).
The type and rate of replacement fluids are based on the type and quantity of fluid lost. You should be clear what type of fluid, and how much of each type, you are giving for each component of the formula and why. However, you should think about replacement and maintenance separately because the types and volumes of the fluids required will be different for each component. Prescribing fluids is not an exact science – most of the time it is the best guess for the patient’s weight/approximate quantity of lost fluid. Overall fluid requirements = replacement of fluid loss + maintenance fluids. It should be read with examination of fluid status and types of iv fluid pages This page describes how to chose and prescribe iv fluids. 
How to prescribe IV fluids How to prescribe IV fluids for medical student exams, finals and OSCEs
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