What is the recommended hourly fluid rate for a 166lbs patient with sepsis?

Fluid Resuscitation Protocol for a 166 lbs Patient with Sepsis

For a 166 lbs (75.3 kg) patient with sepsis, administer at least 30 mL/kg of intravenous crystalloid fluid within the first 3 hours, which equals approximately 2.3 liters (2,259 mL). 1

Initial Fluid Resuscitation

The Surviving Sepsis Campaign guidelines strongly recommend initial fluid resuscitation with 30 mL/kg of crystalloid fluid within the first 3 hours of sepsis recognition 2, 1. This fixed volume enables clinicians to initiate resuscitation while obtaining more specific information about the patient's hemodynamic status.

For a 166 lbs (75.3 kg) patient:

• Initial fluid bolus: 30 mL/kg × 75.3 kg = 2,259 mL
• Administration timeframe: Complete within first 3 hours
• Fluid type: Balanced crystalloid solutions are preferred over normal saline 1

Hourly Fluid Rate Calculation

To administer the initial 2,259 mL over 3 hours:

• Hourly rate = 2,259 mL ÷ 3 hours = 753 mL/hour

Ongoing Fluid Management

After the initial resuscitation:

1. Perform frequent reassessment of hemodynamic status including:

   • Heart rate
   • Blood pressure (target MAP ≥65 mmHg)
   • Arterial oxygen saturation
   • Respiratory rate
   • Temperature
   • Urine output (target ≥0.5 mL/kg/hr)
   • Lactate levels 1

2. Use dynamic variables to guide further fluid administration:

   • Pulse pressure variation
   • Stroke volume variation
   • Passive leg raise test 1

3. Consider vasopressor therapy if hypotension persists despite initial fluid resuscitation 1

Important Considerations

• Many patients will require more than the initial 30 mL/kg of fluid 2. The Surviving Sepsis Campaign notes that more than 4L during the first 24 hours may be required to adequately resuscitate adult septic patients 2.

• Studies have shown that higher fluid volumes administered by 3 hours correlate with decreased mortality, with a plateau effect between 35-45 mL/kg 3.

• Failure to meet the 30 mL/kg target within 3 hours has been associated with increased odds of in-hospital mortality, delayed hypotension, and increased ICU stay 3.

• After initial resuscitation, fluid administration should be judicious to avoid fluid overload, which has been associated with increased mortality and prolonged mechanical ventilation 4.

Caution

While the 30 mL/kg initial bolus is standard, be aware that certain patient populations may require more careful fluid management:

• Patients with heart failure
• Patients with end-stage renal disease
• Elderly patients
• Obese patients

However, evidence suggests that even these "at-risk" populations benefit from meeting the initial 30 mL/kg target 3.