From the Research
For an NPO patient, the recommended IV fluid regimen is typically lactated Ringer's solution, as it has been shown to have fewer adverse effects on acid-base balance and may reduce the need for vasopressors, according to the most recent and highest quality study 1.
Key Considerations
- The choice of IV fluid is crucial in maintaining electrolyte balance and preventing complications such as hyperchloremic metabolic acidosis, inflammation, hypotension, acute kidney injury, and death 2.
- Lactated Ringer's solution has been shown to be a better alternative to normal saline, with a sodium, potassium, and chloride content closer to that of extracellular fluid 2.
- A recent study found that initial fluid resuscitation with lactated Ringer's solution, compared with 0.9% saline, might be associated with improved survival in patients with sepsis-induced hypotension 1.
IV Fluid Regimen
- The recommended rate of IV fluid administration can be calculated using the 4-2-1 rule: 4 mL/kg/hr for the first 10 kg of body weight, plus 2 mL/kg/hr for the next 10 kg, plus 1 mL/kg/hr for each additional kg.
- For electrolyte replacement, potassium chloride (KCl) at 20-40 mEq/L can be added if renal function is normal.
- Patients can generally remain on maintenance IV fluids for up to 5-7 days before requiring nutritional support.
Monitoring and Transition to Nutritional Support
- Daily monitoring of electrolytes, glucose, and fluid status is essential while on IV fluids.
- For prolonged NPO status, consider adding multivitamins after 3 days and transitioning to total parenteral nutrition if enteral feeding remains impossible after 7 days.
- The use of lactated Ringer's solution has been associated with a reduction in major adverse kidney events (MAKE30) and improved clinical outcomes in patients with sepsis-induced hypotension 3, 1.