Fluid Composition for 100cc Solution
For a 100cc fluid bolus in critically ill patients, use a balanced crystalloid solution (such as Lactated Ringer's or Plasmalyte) rather than 0.9% normal saline, as this reduces mortality and prevents hyperchloremic metabolic acidosis. 1, 2
Recommended Fluid Type
Balanced crystalloid solutions are the first-line choice for the vast majority of clinical scenarios, including perioperative fluid management, sepsis resuscitation, and general critical illness 1, 3
Specific balanced solutions include:
These solutions maintain better acid-base balance compared to 0.9% saline, particularly when larger cumulative volumes are administered 1
When to Avoid Balanced Crystalloids
Use 0.9% normal saline instead in these specific situations:
Traumatic brain injury with focal neurological signs - isotonic saline is preferred over balanced crystalloids due to concerns about hypotonic effects 1, 3
Hypochloremia - balanced solutions should be avoided when serum chloride is already low 1
Diabetic ketoacidosis - 0.9% normal saline remains the recommended fluid 2
Volume Considerations for 100cc
While 100cc represents a small volume, the choice of fluid type matters because:
Cumulative chloride load from repeated normal saline boluses causes hyperchloremic metabolic acidosis, renal vasoconstriction, and increased cytokine secretion 1
Even when individual boluses are small, total volumes often exceed 1-2 liters during resuscitation, making fluid composition clinically significant 1
Fluids to Avoid
Synthetic colloids (hydroxyethyl starch) are not recommended due to increased risk of renal failure and coagulation disorders 1, 4
Albumin should not be used routinely, as it offers no mortality benefit over crystalloids and is significantly more expensive 1, 4, 3
Hypertonic saline solutions (3% or 7.5%) are not recommended for routine resuscitation as they show no mortality benefit 1, 4
Hypotonic solutions should be avoided in neurosurgical patients 1
Administration Parameters
When ordering your 100cc bolus, specify:
- Fluid type (e.g., "Lactated Ringer's 100cc") 2
- Rate of administration (e.g., "IV over 15 minutes") 2
- Reassessment triggers after the bolus (heart rate, blood pressure, respiratory rate, urine output) 2, 4
Common Pitfalls
Avoid defaulting to normal saline out of habit - the evidence strongly favors balanced crystalloids in most scenarios 1, 2, 3
Do not order continuous fluids without reassessment intervals, as this leads to fluid overload 2
Limit normal saline to maximum 1-1.5 L total if it must be used, to minimize hyperchloremic acidosis 2