General principles and patient assessment
- Changes in volume (e.g., dehydration, blood loss)
- Changes in content (e.g., hyperkalemia)
- Changes in distribution (e.g., pleural effusion)
The initial assessment includes evaluation of hydration, tissue perfusion, and fluid volume/loss. Items of particular importance in evaluating the need for fluids are described in Table 1. Next, develop a treatment plan by first determining the appropriate route of fluid administration. Guidelines for route of administration are shown in Table 2.
Consider the temperature of the fluids. Body temperature (warmed) fluids are useful for large volume resuscitation but provide limited usefulness at low IV infusion rates. It is not possible to provide sufficient heat via IV fluids at limited infusion rates to either meet or exceed heat losses elsewhere.1
Evaluation and monitoring parameters that may be used for patients receiving fluid therapy
Determining the route of fluid administration
|Patient parameter||Route of fluid administration|
|Gastrointestinal tract is functional and no contraindications exist (e.g., vomiting)||Per os|
|Anticipated dehydration or mild fluid volume disturbances in an outpatient setting||Subcutaneous. Caution: use isotonic crystalloids only. Do not use dextrose, hypotonic (i.e., D5W), or hypertonic solutions. Subcutaneous fluids are best used to prevent losses and are not adequate for replacement therapy in anything other than very mild dehydration|
|Hospitalized patients not eating or drinking normally, anesthetized patients, patients who need rapid and/or large volume fluid administration (e.g., to treat dehydration, shock, hyperthermia, or hypotension)||IV or intraosseous|
|Critical care setting. Used in patients with a need for rapid and/or large volume fluid administration, administration of hypertonic fluids and/or monitoring of central venous pressure||Central IV|
D5W, 5% dextrose in water.