IV Fluids

IV fluids ppt

Where to start

Fluid Assessments

What's the goal of the Fluids?

IV fluids ppt

https://1drv.ms/p/c/8e3978bb3565faa8/IQBSnVzcHU26Sq5lNoZkix4iAQ76VdCCcWKUsJWCRRMUhCs

Where to start

Calls about fluids are a common day to day thing. They'll range from the fluids for this patient have finished... do you want more, what time frame do you want this bag run over to the patient looks a little dry, can you review?

At times it'll feel like the patient is on a seesaw waiting to tip from optimal balance to dehydration on one side to overloaded on the other. Keeping them in a neutral position, can feel like an impossible aim when you're contending with intercurrent illnesses, nausea and vomiting, or patients who have underlying conditions like congestive cardiac failure or chronic kidney disease that pushes them to one side or the other before you even start to get involved.

The diagram on the left demonstrates the clinical signs and symptoms of dehydration of fluid overload. (1,3)

Types of Fluid:

Crytalloids:

Generally the mainstay of fluids used in day to day practice.
Normal saline or Hartmanns.

Colloids

They contain larger particles like starch or proteins that act to keep fluid in the blood vessel.
Generally less used as higher risk of allergic reactions
Examples include albumin and gelafusin

Fluid Assessments

What we prescribe does matter though. Too much fluid can contribute to fluid overload and place strain on the patients cardiovascular system and too little can lead to acute kidney injuries, amongst other things.

Issues like the above can all delay recovery and increase morbidity and mortality rates

Starting with a good fluid assessment structure is key. As with most things a targeted history is useful. Try to elicit if there are signs of excessive loss, if there is evidence of bleeding, fever, diuretic use or known conditions like heart failure.

Then use a structured examination style like ABCDE and consider what clinical signs and symptoms are present that suggest the patient is hypovolaemic, euvolaemic or hypervolaemic.(1,2,3)

The above diagram is an attempt to grade clinical signs assessed during fluid assessments into green which I think are the most useful to orange which is the most subjective in my own opinion. As I said though this is my own opinion

What's the goal of the Fluids?

This is another important consideration and can be thought of in terms of resuscitation, maintenance and replacement. There's a lot that can be said here but to keep it simple.

Resuscitation - acute replacements of fluids, usually in bolus doses
Maintenance - Meeting a patients daily needs for water and electrolytes
Replacement - Additional requirements based on the patients specific clinical circumstances and any ongoing losses.

I would really recommend looking at the linked resourses as NICE have some excellent guidance on fluid prescribing in alogrithm form which I think are very useful.(1,2)

Disclaimer:

This is a not for profit education resource designed for new resident doctors. All information serves as a guide to help doctors approach day to day life as an F1. It is not intended as a guide to patient care and should never be used as such or in place of advice of treating clinicians or published clinical guidelines. All cases are fictional and any resemblance is purely coincidental. Additionally all images are AI generated unless otherwise stated.

REFERENCES:

National Institute for Health and Care Excellence (2013 (updated 2016)). Intravenous Fluid Therapy In Adults In Hospital. Available at:
National Institute for Health and Care Excellence (2013 (updated 2016)). Intravenous Fluid Therapy In Adults In Hospital. Research recommendations. Available at:
Hypovolemia · What Is It, Causes, Signs, and More. (2025). Osmosis. https://www.osmosis.org/answers/hypovolemia

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