From the Guidelines
For dehydration, isotonic crystalloid solutions like 0.9% Normal Saline (NS) or Lactated Ringer's (LR) are the preferred IV fluids, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. These solutions effectively restore intravascular volume by expanding the extracellular fluid compartment.
- For mild to moderate dehydration, administration rates of 500-1000 mL over 1-2 hours are common, followed by maintenance fluids as needed.
- For severe dehydration, more rapid infusion may be required, with 1-2 L given over the first hour, followed by reassessment. The choice between NS and LR depends on the patient's specific electrolyte abnormalities and acid-base status.
- NS contains higher sodium and chloride concentrations which may cause hyperchloremic metabolic acidosis with large volumes,
- while LR more closely resembles plasma composition. For patients with specific electrolyte deficiencies, such as hypokalemia, fluids with added potassium may be used once adequate urine output is established. However, the most recent guidelines for the choice of intravenous fluids for vascular filling in critically ill patients, published in 2022, also support the use of balanced crystalloids like LR 1. Dextrose-containing solutions like D5W are generally not first-line for volume resuscitation but may be added when hypoglycemia is present or for maintenance fluids. It is essential to note that the primary goal is to restore blood volume and reduce hypovolaemia, and the choice of IV fluid should be based on the patient's individual needs and clinical situation.
From the FDA Drug Label
If the patient is dehydrated, additional crystalloids must be given,(4) or alternatively, Albumin (Human) 5%, USP (Plasbumin®-5) should be used.
The IV fluid used for dehydration is crystalloids or Albumin (Human) 5%, USP (Plasbumin®-5), as stated in the drug label 2. Key points to consider:
- Dehydration requires additional fluid administration
- Crystalloids can be used to treat dehydration
- Albumin (Human) 5%, USP (Plasbumin®-5) is an alternative option for dehydration treatment
From the Research
IV Fluids for Dehydration
- Lactated Ringer's solution and 0.9% saline are commonly used IV fluids for dehydration 3.
- A study compared the effects of lactated Ringer's solution and 0.9% saline on patients with sepsis-induced hypotension, and found that lactated Ringer's solution might be associated with improved survival 3.
- Another study investigated the short-term metabolic effects of maintenance fluid therapy with saline, dextrose-supplemented saline, or lactated Ringer's solution in children with acute gastroenteritis, and found that the three solutions had different effects on metabolic balance 4.
- Normal saline, dextrose-supplemented saline, and lactated Ringer's solution are also used for maintenance fluid therapy in children with mild to moderate dehydration 4.
Types of IV Fluids
- Lactated Ringer's solution: may be associated with improved survival in patients with sepsis-induced hypotension 3.
- 0.9% saline: commonly used for initial fluid resuscitation, but may be associated with higher levels of serum chloride and decreased levels of serum bicarbonate 3.
- Dextrose-supplemented saline: may have a positive effect on plasma bicarbonate and influence blood glucose levels 4.
- Normal saline: may not have a significant effect on plasma bicarbonate, but can be used for maintenance fluid therapy in children with mild to moderate dehydration 4.