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General Principles and Patient Assessment

The assessment of patient history, chief complaint, and physical exam findings will determine the need for additional testing and fluid therapy. Assess for the following three types of fluid disturbances:
  1. Changes in volume (e.g., dehydration, blood loss)
  2. Changes in content (e.g., hyperkalemia)
  3. 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

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