Subcutaneous Fluid Rate for Adults
For adult patients requiring subcutaneous fluid administration, the recommended starting rate is 1-2 mL/minute (60-120 mL/hour), with a maximum of 3 L per 24 hours administered at two separate sites. 1
Subcutaneous Fluid Administration Guidelines
Maximum Volume and Rate
- Maximum volume: Approximately 3 L can be given in a 24-hour period using two separate sites 1
- Each site can absorb approximately 1.5 L per 24 hours
- Starting rate: 1-2 mL/minute (60-120 mL/hour)
- Rate can be adjusted based on patient tolerance and clinical response
Preferred Solutions
- Normal saline (0.9% NaCl) is the preferred solution for subcutaneous hydration 1
- Alternative solutions that can be used:
- Half-normal saline (0.45% NaCl)
- 5% glucose with saline
- 5% glucose solution
Administration Sites
- Common infusion sites include:
- Chest
- Abdomen
- Thighs
- Upper arms
Monitoring and Adjustments
- Monitor for local edema, which is the most common adverse effect 1
- Adjust rate based on:
- Patient tolerance
- Urine output (target 0.5-1 mL/kg/hour in adults) 2
- Clinical improvement of hydration status
Clinical Applications and Considerations
Indications
- Mild to moderate dehydration in adults, especially the elderly 1, 3
- When intravenous access is difficult or not feasible
- For patients requiring fluid maintenance but not requiring rapid volume expansion
Advantages
- Subcutaneous rehydration is as effective as intravenous rehydration for mild to moderate dehydration 3
- Lower risk of phlebitis compared to intravenous administration 3
- Can be administered at home by family members or nurses 1
- Cost-effective alternative to intravenous therapy 4
Enhancing Absorption
- Hyaluronidase can be added to enhance fluid absorption if needed 1
- Local massage can help reduce subcutaneous edema 1
Special Considerations
- For severe dehydration or when greater fluid volumes are needed, intravenous administration is preferred 2
- Potassium chloride can be added to the solution if needed 1
- In elderly patients with measured serum osmolality >300 mOsm/kg, subcutaneous fluids can be offered in parallel with encouraging oral fluid intake 2
Cautions and Contraindications
- Not suitable for patients requiring rapid fluid resuscitation (e.g., severe burns, anaphylaxis)
- For severe burns, initial fluid resuscitation should follow established formulas (e.g., Parkland formula at 4 mL/kg/%TBSA) 2, 5
- For anaphylaxis, intravenous crystalloids at 5-10 mL/kg in the first 5 minutes are recommended 2
- Monitor for local adverse effects such as edema, which can be treated with local massage or systemic diuretics if severe 1
Subcutaneous fluid administration is a safe, effective, and practical alternative to intravenous hydration for appropriate patients, particularly when intravenous access is challenging or when treating mild to moderate dehydration in the elderly.