From the Guidelines
Maintenance IV fluids should be administered using isotonic solutions with appropriate potassium chloride and dextrose to prevent hyponatremia and acute or permanent neurologic impairment. The standard formula for calculating maintenance fluids is based on body weight: 4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the next 10 kg, and 1 mL/kg/hr for each additional kg 1. Common maintenance solutions include 0.9% normal saline, 0.45% normal saline, and 5% dextrose solutions, often with added potassium chloride (typically 20-40 mEq/L) 1. The rationale for maintenance fluids is to replace ongoing losses from urine, stool, respiration, and insensible losses while maintaining electrolyte balance. These fluids prevent dehydration, maintain kidney function, and support cellular processes. The composition mimics normal physiological needs, with sodium typically at 30-40 mEq/L and potassium at 20-40 mEq/L.
Some key points to consider when administering maintenance IV fluids include:
- Using isotonic fluids to reduce the risk of hyponatremia 1
- Considering the use of balanced solutions to slightly reduce length of stay 1
- Providing glucose in sufficient amounts to prevent hypoglycaemia, guided by blood glucose monitoring 1
- Avoiding excessive glucose provision to prevent hyperglycaemia 1
- Adding appropriate amounts of potassium to prevent hypokalemia, based on the child’s clinical status and regular potassium level monitoring 1
- Regularly monitoring electrolytes, fluid balance, and clinical status to prevent complications like fluid overload or electrolyte imbalances 1
It is also important to note that the use of hypotonic maintenance IV fluids has been associated with an increased risk of hyponatremia and hyponatremic encephalopathy, particularly in children 1. Therefore, the use of isotonic solutions is recommended to minimize this risk. Additionally, the total daily amount of maintenance fluid therapy should be considered, including all IV fluids, blood products, and enteral intake, to prevent fluid creep and reduce fluid intake 1.
From the FDA Drug Label
Beyond 24 hours Plasbumin-25 can be used to maintain plasma colloid osmotic pressure. When clinical signs are those of hypoproteinemia with a fluid volume overload, Plasbumin-25 together with a diuretic may play a role in therapy The maintenance IV fluid rationale for using albumin is to maintain plasma colloid osmotic pressure and to treat hypoproteinemia. Albumin may be used in situations where there is a need to expand plasma volume or to bind excess plasma bilirubin. Key indications for albumin use include:
- Hypoproteinemic states involving reduced oncotic pressure
- Fluid volume overload with hypoproteinemia
- Acute liver failure
- Severe hemolytic disease in neonates awaiting exchange transfusion 2 2
From the Research
Maintenance IV Fluid Rationale
- The choice of maintenance IV fluid is crucial in preventing complications and improving patient outcomes 3, 4, 5, 6.
- Balanced crystalloid solutions, such as lactated Ringer's, are preferred over unbalanced solutions like saline due to their closer composition to extracellular fluid 3, 6.
- Balanced solutions have been shown to reduce the risk of hyperchloremic metabolic acidosis, inflammation, hypotension, acute kidney injury, and death 6.
- The use of hypertonic solutions may be beneficial in small volume resuscitation, but they carry the risk of hypernatremia 3.
- Isotonic and hypertonic crystalloid fluids are the fluids of choice for resuscitation from hypovolemia and shock 3.
- The selection of IV fluid should be based on the patient's individual needs and goals of therapy, taking into account factors such as fluid volume, electrolyte balance, and acid-base status 4, 5.
- Nurses play a vital role in monitoring the safety and efficacy of IV fluid therapy and selecting the optimal fluid for each patient 4.
- Recent studies have compared the effects of different IV fluids, including saline and lactated Ringer's solution, on red blood cell transfusions and storage lesions 7.