From the Guidelines
For a patient who is NPO for a short term of a few days, I strongly recommend using balanced crystalloids, such as Ringer’s lactate, for IV fluid repletion, as it is the most appropriate choice to maintain intravascular volume and avoid electrolyte imbalances 1. When selecting an IV fluid, it is crucial to consider the patient's individual needs and the potential risks associated with different types of fluids.
- The use of 0.9% saline should be avoided due to the risk of salt and fluid overload 1.
- Oliguria should not trigger fluid therapy, but rather be investigated to establish the cause prior to additional fluid therapy 1.
- Postoperatively, IVF should be discontinued at the latest during day 1, and patients should be encouraged to drink when fully recovered and offered an oral diet within 4 hours after abdominal/pelvic surgery 1.
- If IVF needs to be continued postoperatively, a hypotonic crystalloid with 70-100 mmol/day of sodium and up to 1 mmol/kg/day of potassium should be used 1. The goal is to achieve a near-zero fluid balance, which is recommended to prevent complications associated with over or under hydration 1. It is essential to monitor the patient's fluid status closely, using parameters such as intake and output, daily weights, and clinical assessment of hydration status, to ensure that the IV fluid repletion is effective and safe.
- Electrolyte replacement should be guided by laboratory values, with potassium supplementation added if levels are low 1.
- The specific rate of IV fluid administration can be calculated based on the patient's weight, using a formula such as 4 mL/kg for the first 10 kg of body weight, plus 2 mL/kg for the next 10 kg, plus 1 mL/kg for each additional kg, all per hour. By following these guidelines, healthcare providers can ensure that patients receive the most appropriate IV fluid repletion, minimizing the risk of complications and promoting optimal outcomes 1.
From the Research
IVF Repletion Option for Patient NPO Short Term
- The provided studies do not directly address the IVF repletion option for a patient who is NPO (nil per os, or nothing by mouth) for a short term, such as a couple of days.
- However, study 2 discusses the diagnosis and management of infertility, including the use of IVF, but does not mention NPO or short-term fasting as a factor in IVF treatment.
- Study 3 evaluates the effect of a freeze-all strategy on IVF outcomes in poor ovarian responders, but does not address the issue of NPO or short-term fasting.
- Study 4 assesses the effect of prolonged progesterone support on pregnancy outcomes in women undergoing fresh embryo transfer after IVF, but does not mention NPO or short-term fasting.
- Study 5 discusses hormonal changes during menopause and their impact on fluid regulation, which may be relevant to IVF treatment, but does not directly address the issue of NPO or short-term fasting.
- Study 6 examines the association between follicular fluid progesterone level and fertilization outcome after IVF, but does not mention NPO or short-term fasting.
- In general, the provided studies do not offer evidence to support or refute the use of IVF repletion for a patient who is NPO for a short term, and more research would be needed to determine the safety and efficacy of this approach 2, 3, 4, 5, 6.