From the Guidelines
Intravenous (IV) fluids should be chosen based on the patient's clinical condition, electrolyte status, and comorbidities, with a preference for balanced crystalloids like Lactated Ringer's for large volume resuscitation and Normal Saline for hypochloremic metabolic alkalosis, as recommended by the most recent guidelines 1. The main types of IV fluids include crystalloids and colloids, with crystalloids being the most commonly used. Crystalloids are classified into isotonic, hypotonic, and hypertonic solutions. Isotonic solutions like Normal Saline (0.9% NaCl) and Lactated Ringer's are appropriate for most fluid resuscitation needs and volume replacement.
- Normal Saline is ideal for hypochloremic metabolic alkalosis and can be used safely in most patients, though excessive amounts may cause hyperchloremic metabolic acidosis.
- Lactated Ringer's is preferred for large volume resuscitation as it more closely resembles plasma composition.
- Hypotonic solutions like 0.45% NaCl (half-normal saline) are useful for free water replacement in hypernatremia but should be avoided in patients with increased intracranial pressure or at risk for cerebral edema.
- Hypertonic solutions (3% NaCl) are reserved for severe symptomatic hyponatremia.
- Dextrose solutions such as D5W (5% dextrose in water) provide free water and calories, becoming hypotonic once the dextrose is metabolized, making them suitable for maintenance fluids and medication dilution. For patients with specific electrolyte deficiencies, consider D5NS (dextrose with normal saline) for both hydration and glucose provision, or solutions with added potassium (typically 20-40 mEq/L) for hypokalemia. The choice of IV fluid should be guided by the patient's clinical condition, with careful monitoring of vital signs, urine output, and electrolyte levels during administration, as recommended by recent guidelines 1. In cases of severe dehydration, shock, or altered mental status, isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered, as recommended by the Infectious Diseases Society of America 1. Additionally, the Surviving Sepsis Campaign guidelines recommend the use of crystalloids as first-line fluid resuscitation, with a suggested initial volume of at least 30 mL/kg of IV crystalloid fluid within the first 3 hours 1. It is also important to consider the potential risks and benefits of different IV fluids, such as the risk of hyperchloraemic acidosis with normal saline, and to choose the most appropriate fluid based on the individual patient's needs, as discussed in recent studies 1.
From the FDA Drug Label
Emergency Treatment of Hypovolemic Shock Plasbumin-25 is hyperoncotic and on intravenous infusion will expand the plasma volume by an additional amount, three to four times the volume actually administered, by withdrawing fluid from the interstitial spaces, provided the patient is normally hydrated interstitially or there is interstitial edema. If the patient is dehydrated, additional crystalloids must be given,(4) or alternatively, Albumin (Human) 5%, USP (Plasbumin®-5) should be used. Beyond 24 hours Plasbumin-25 can be used to maintain plasma colloid osmotic pressure. Hypoproteinemia With or Without Edema During major surgery, patients can lose over half of their circulating albumin with the attendant complications of oncotic deficit.(2,4,5) Adult Respiratory Distress Syndrome (ARDS)(2,5) This is characterized by deficient oxygenation caused by pulmonary interstitial edema complicating shock and postsurgical conditions. When clinical signs are those of hypoproteinemia with a fluid volume overload, Plasbumin-25 together with a diuretic may play a role in therapy
The different types of IV fluids that can be ordered include:
- Crystalloids: for dehydration or to be given in addition to Plasbumin-25 in cases of hypovolemic shock
- Albumin (Human) 5%, USP (Plasbumin®-5): for volume deficits, or as an alternative to crystalloids in dehydrated patients
- Plasbumin-25:
- for emergency treatment of hypovolemic shock
- to maintain plasma colloid osmotic pressure beyond 24 hours
- for hypoproteinemia with or without edema
- for adult respiratory distress syndrome (ARDS) with hypoproteinemia and fluid volume overload
- for other conditions such as burn therapy, cardiopulmonary bypass, acute liver failure, neonatal hemolytic disease, sequestration of protein rich fluids, erythrocyte resuspension, and acute nephrosis 2, 2
From the Research
Types of IV Fluids
- Crystalloid fluids: used for resuscitation and maintenance of fluid balance 3
- Colloid fluids: used for volume expansion and shock treatment 3
Choosing the Right IV Fluid
- Consider the patient's condition and the desired outcome 4
- Balanced fluids are recommended for perioperative use to minimize adverse effects 4
- Hydroxyethyl starches are not recommended due to possible adverse effects 4
Indications for IV Fluids
- Resuscitation of the critically ill 3
- Perioperative care 4
- Maintenance of fluid balance 3
- Volume expansion and shock treatment 3
Properties and Adverse Effects of IV Fluids
- Crystalloid fluids: hypotonic, isotonic, or hypertonic, with potential adverse effects such as fluid overload and electrolyte imbalances 3
- Colloid fluids: potential adverse effects such as anaphylaxis and coagulopathy 3