From the Guidelines
Intravenous (IV) fluids should be chosen based on the patient's specific condition, with crystalloids like Normal Saline (0.9% NaCl) and Lactated Ringer's being the primary choice for fluid resuscitation, while colloids like albumin and plasma expanders are used in specific situations like hypovolemic shock or severe sepsis, as recommended by recent guidelines 1.
Types of IV Fluids
- Crystalloids:
- Normal Saline (0.9% NaCl) for fluid resuscitation and sodium deficiencies
- Lactated Ringer's for trauma patients and balanced electrolyte solution
- Dextrose solutions (e.g., D5W) for hypoglycemia and maintenance hydration
- Hypertonic saline (3% or 7.5% NaCl) for severe hyponatremia or intracranial pressure reduction
- Colloids:
- Albumin (5% or 25%) for maintaining oncotic pressure in hypovolemic shock
- Plasma expanders (e.g., Hetastarch) for temporary blood volume increase
Selection of IV Fluids
The choice of IV fluid depends on factors like electrolyte status, acid-base balance, and hemodynamic stability, with balanced crystalloids being associated with reduced mortality in critically ill patients 1.
Administration and Monitoring
Proper administration requires monitoring vital signs, electrolytes, and fluid balance to prevent complications like fluid overload, electrolyte imbalances, or acid-base disturbances, with clinical endpoints guiding initial resuscitation rather than predetermined protocols 1.
Recent Guidelines
Recent guidelines, such as the Surviving Sepsis Campaign and the AASLD practice guidance, recommend the use of crystalloids as the first line of treatment, with colloids being used in specific situations, and emphasize the importance of individualized fluid management and monitoring 1.
From the Research
Types of IV Fluids
- Crystalloids: These are the most commonly used IV fluids and are categorized into isotonic, hypotonic, and hypertonic solutions 2, 3, 4.
- Colloids: These include albumin and semi-synthetic colloids, which are used to treat hypovolemia but may have adverse effects such as impaired renal function 5, 4.
Specific IV Fluids
- Normal Saline (0.9% sodium chloride): Associated with the development of hyperchloremic metabolic acidosis and renal vasoconstriction 2, 3.
- Lactated Ringer's: A balanced crystalloid solution that is often preferred over normal saline, but should not be given in patients with severe metabolic alkalosis, lactic acidosis, or severe hyperkalemia 2, 5.
- Balanced Crystalloid Solutions (e.g., Plasma-Lyte): Have a sodium, potassium, and chloride content closer to that of extracellular fluid and may have fewer adverse effects on acid-base balance 3.
- Albumin: May impair renal function and has uncertain benefits in the resuscitation of patients with severe sepsis and septic shock 5, 4.
Clinical Considerations
- The choice of IV fluid should be guided by the cause of hypovolemia, cardiovascular state, renal function, and serum osmolality, as well as coexisting acid-base and electrolyte disorders 2, 6.
- IV fluids should be used judiciously, as inappropriate use can have detrimental effects, and nurses play a vital role in monitoring the safety and efficacy of IV fluid therapy 6.