Recommended Flow Rate for 1L Saline in Mild Dehydration
For a patient with mild dehydration, a 1L saline drip should be administered at a rate of 5-10 mL/kg in the first 5 minutes, followed by continued infusion to complete the liter within 2-4 hours.
Assessment of Dehydration
- Mild dehydration is typically defined as 3-5% fluid deficit
- Clinical signs include:
- Mild thirst
- Dry mucous membranes
- Normal to slightly decreased skin turgor
- Normal vital signs
Recommended Flow Rate Protocol
Initial Bolus (First 5 Minutes)
- Administer normal saline at 5-10 mL/kg 1
- For a 70kg adult, this equals approximately 350-700 mL in the first 5 minutes
Subsequent Infusion
- After initial bolus, slow the rate to complete the remaining volume over 2-4 hours
- For mild dehydration, total fluid replacement should be 50 mL/kg of ORS equivalent 2
- Monitor vital signs every 15-30 minutes during initial rehydration
Type of Saline Solution
- 0.9% normal saline is appropriate if corrected serum sodium is low 1
- 0.45% saline may be more appropriate if corrected serum sodium is normal or elevated 1
- Balanced crystalloid solutions (e.g., Ringer's lactate) may be preferable as they likely result in slightly shorter hospital stays and better correction of metabolic acidosis 3
Electrolyte Considerations
- Once renal function is confirmed and serum potassium is known, consider adding 20-30 mEq/L potassium (2/3 KCl and 1/3 KPO₄) to the infusion 1
- Monitor serum electrolytes, particularly sodium and potassium, during rehydration
Special Considerations
- For patients with congestive heart failure or chronic renal disease, use caution to prevent volume overload 1
- For elderly patients or those with cardiovascular disease, slower infusion rates may be necessary
- If the patient shows signs of worsening dehydration or develops severe dehydration, increase the rate accordingly
Monitoring During Infusion
- Successful fluid replacement should be judged by:
- Improvement in blood pressure
- Measurement of fluid input/output
- Clinical examination (improved skin turgor, moist mucous membranes)
- Resolution of thirst
Pitfalls to Avoid
- Avoid overly rapid correction in patients with chronic hyponatremia (should not exceed 3 mOsm/kg/h) 1
- Do not use dextrose-containing solutions for initial rehydration as dextrose is rapidly extravasated from intravascular circulation 1
- Avoid using sports drinks, fruit juices, or sodas for rehydration as they lack proper electrolyte balance 2
- Don't delay oral feeding once the patient is stabilized, as early reintroduction of food is beneficial 2
Remember that fluid replacement should correct estimated deficits within 24 hours, with careful monitoring of the patient's clinical status throughout the rehydration process.