Intravenous Fluids

▪Fluid Maintenance

Maintenance rate

Maintenance requirements: (4-2-1 Rule)

1-10 kg = 4 cc/kg/hr

40 cc

(110 cc for a 70 kg pt)

11-20 kg = 2 cc/kg/hr

20 cc

≥ 21 kg = 1 cc/kg/hr

50 cc
Multiply maintenance rate by N of hrs NPO = for deficit.
Gradually replace deficit:

1/2 in hour 1

1/4 in hour 2

1/4 in hour 3

Replacement of 3rd space loss:

Minimum procedure: 2-4 cc/kg/hr

Moderate procedure: 4-6 cc/kg/hr

Severe procedure: 6-8 cc/kg/hr

Chart to Determine IV Fluid Replacement

	1	2	3	4	5
Maintenance
Deficit Hours NPO					Total Deficit:
3rd Space 2-3; 4-6 6-8 cc/kg/hr
EBL Lost/replaced 3:1 crystal 1:1 colloid
Total cc per hour

▪Colloids

There is no risk of transmission of hepatitis with albumin or plasma protein fractions due to heat treatment to 60°C for 10 hrs.The half-life of a colloid is 3-6 hrs.

Two types:

Blood derived (albumin): The half-life of albumin is 14-21 days (albumin is 70% of oncotic pressure).

Synthetic colloids (dextrose starches)

Dextran: Max dose: 20 cc/kg/day. Improves microcirculation by decreasing blood viscosity and antiplatelet effects. Antigenic, associated with both anaphylactic and anaphylactoid reactions.
Hetastarch/Hextend: Max dose: 20 cc/kg/day or ˜1500 mL. (Note: Greater than 20 mL/kg will lead to platelet dysfunction and bleeding.) Less expensive than albumin. Nonantigenic, anaphylactoid reactions are rare. Can increase indirect serum bilirubin and serum amylase levels for up to 5 days after administration. A complex polysaccharide, these are large molecules that must be broken down by serum amylase before being removed from circulation by renal excretion and redistribution. Hextend contains Ca and should not be given with blood products. Contains lactate.

Hespan®

Do not exceed 1500 mL/day IV or not to exceed 20 mL/kg.

Expands blood volume for 36 hours.

Contraindicated in patients with severe bleeding disorders, severe CHF, or renal failure with oliguria or anuria.

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