From the Guidelines
The recommended first-line fluid for resuscitation or maintenance in patients requiring intravenous fluids is 0.9% sodium chloride (normal saline) or balanced crystalloid solutions such as lactated Ringer's or Plasma-Lyte. This recommendation is based on the most recent and highest quality evidence available, which suggests that crystalloids should be used as the initial fluid of choice in the resuscitation of severe sepsis and septic shock 1. For most adult patients, an initial bolus of 500-1000 mL over 15-30 minutes may be appropriate for resuscitation, followed by reassessment.
Key Considerations
- For maintenance, typical rates range from 1-3 mL/kg/hr based on the patient's weight, clinical condition, and ongoing losses.
- Isotonic crystalloids are preferred because they expand the intravascular space effectively while maintaining appropriate electrolyte balance.
- Balanced solutions like lactated Ringer's may be particularly beneficial in patients at risk for hyperchloremic metabolic acidosis from large volume normal saline administration.
- Colloids (like albumin) are generally not first-line except in specific circumstances such as liver disease with ascites.
- When administering IV fluids, regular monitoring of vital signs, urine output, electrolytes, and acid-base status is essential to prevent complications like fluid overload or electrolyte disturbances.
Clinical Scenarios
- In patients with suspected infection and evidence of possible hypovolemia, crystalloid fluid resuscitation is recommended 1.
- In patients with refractory haemodynamic instability following intravenous administration of crystalloid, repeat boluses or continued infusion at a lower rate may be considered 1.
- In patients with likely fluid intolerance, clinical reassessment to detect fluid overload and/or pulmonary oedema is crucial, and reduction in the rate of fluid infusion may be necessary 1.
From the Research
Recommended First-Line Fluid for Resuscitation or Maintenance
The recommended first-line fluid for resuscitation or maintenance in patients requiring intravenous (IV) fluids is a topic of ongoing discussion.
- 0.9% sodium chloride is commonly used for fluid resuscitation in various clinical settings, including trauma care 2 and critically ill adults 3.
- However, recent studies suggest that balanced salt solutions may be preferred in some patient populations, such as those with diabetic ketoacidosis, as they may result in faster resolution of the condition compared to 0.9% saline 4.
- The choice of fluid depends on various factors, including the patient's underlying condition, fluid requirements, and potential risks of fluid overload or electrolyte imbalances 5.
- It is essential to monitor patients closely and adjust fluid therapy accordingly to ensure optimal outcomes and minimize potential complications 3, 6.
Considerations for Fluid Resuscitation
When selecting a fluid for resuscitation or maintenance, consider the following factors:
- The patient's fluid requirements and volume status
- The type of fluid and its potential impact on electrolyte balance and hemodynamics
- The patient's underlying condition and potential risks of fluid overload or electrolyte imbalances
- The need for close monitoring and adjustment of fluid therapy to ensure optimal outcomes 3, 4, 2, 5, 6