When can Intravenous (IV) fluids be administered?

From the Guidelines

Intravenous (IV) fluids can be administered in cases of severe dehydration, shock, or altered mental status, as well as when oral rehydration therapy (ORT) fails or is not tolerated 1.

Indications for IV Fluids

• Severe dehydration
• Shock
• Altered mental status
• Failure of ORT
• Ileus
• Ketonemia, where an initial course of intravenous hydration may be needed to enable tolerance of oral rehydration 1

Administration Guidelines

• At least 30 mL/kg of IV crystalloid fluid should be given within the first 3 hours in cases of sepsis-induced hypoperfusion 1
• Isotonic intravenous fluids such as lactated Ringer’s and normal saline solution should be administered in cases of severe dehydration, shock, or altered mental status and failure of ORT 1
• IV fluids should be guided by frequent reassessment of hemodynamic status, including a thorough clinical examination and evaluation of available physiologic variables 1

Patient Populations

• Children who are acutely ill and cannot receive sufficient fluids through enteral administration, such as those with gastrointestinal illness, respiratory compromise, or neurologic impairment 1
• Neonates who are younger than 28 days old or in the NICU, as well as adolescents older than 18 years old 1

Key Considerations

• The choice of IV fluid and administration rate should be individualized based on the patient's specific needs and clinical status 1
• Maintenance IV fluids should be used to provide critical supportive care for patients who are acutely ill, while also replacing anticipated physiologic water and electrolyte losses 1

From the Research

Administration of Intravenous (IV) Fluids

Intravenous (IV) fluids can be administered in various situations, including:

• To resuscitate the circulation in hypovolemia-associated shock states 2
• To compensate for an impending or existing fluid extracellular deficit 2
• As a maintenance infusion if the patient is incapable of taking fluid by other means 2
• To maintain hydration and as diluents for drug administration in hospitalized patients 3

Patient Populations

IV fluids are commonly administered in:

• Critically ill adults, with over 20% of patients in intensive care units (ICUs) receiving intravenous fluid resuscitation each day 3
• Acutely ill patients, where IV fluid therapy is the most frequent therapeutic intervention 2
• Patients in intensive care units, where the management of fluid therapy is challenging due to dynamic fluid requirements 4

Fluid Selection

The selection of IV fluids depends on various factors, including:

• The type and composition of the fluid, with balanced crystalloid solutions being the first choice for most acute conditions 2
• The dose and rate of administration, which should be based on dynamic parameters that predict volume responsiveness 5
• The potential toxicity of the fluid, with differences in chloride load and strong ion difference appearing to be clinically important 5