Hospitals & Services

Fluids and Electrolytes

Principles of fluid Management in Intensive Care

Maintenance

  • Daily total fluid administration including enteral feeding = 30-40 ml/kg/day or 80-120 ml/hr, selected according to patient serum sodium and/or glucose tolerance + additional fluid tailored to excessive losses where appropriate.

      • 4% dextrose and 0.18% (1/5th normal saline)

      • 0.9% (normal) saline

      • 5% dextrose

 

Resuscitation and Replacement Fluids

 
The intensive care community is divided on the relative suitability of each fluid in the resuscitation of a critically ill patient.  Crystalloid is the resuscitation fluid used in all patients in the Christchurch Intensive Care except for cardiac-surgical patients.

Normal saline is the preferred crystalloid solution.  However if it is anticipated that significant volumes of fluid are going to be required and because hyperchloraemic metabolic acidosis could be an issue, then Plasmalyte 1 48 should be considered as an alternative and discussed with the duty Intensive Care Specialist.

 
Fluid boluses should optimally be titrated against a measureable end-point.

 

Composition of Commonly Used Fluids

 

​Solution

​Na

mmol/L

​K

mmol/L

​Cl

mmol/L

​Ca

mmol/L

Normal saline (0.9%)​​150​150
Plasmalyte 148​​140​5.0​98

4% Dextrose

0.18% saline

(D4S)​

30​​30
5% Dextrose​

Hartmanns

(lactated ringers solution)​

​129​5.0​109​2.0
4% Albumin​​70​62.5

 

​Solution

​Buffer

mmol/L

​Gluc

(g)

​Osm

​Prot.

(g)

​Mg

mmol/L

Normal saline (0.9%)​300​
Plasmalyte 148​

Acetate 27

Gluconate 23​

1.5​

4% Dextrose

0.18% saline

(D4S)

40

​282
5% Dextrose​​50​​278

Hartmanns

(lactated ringers solution)

Lactate

29​

​274
4% Albumin​​25​

 

Page last reviewed: 13 May 2014
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