The document discusses intravenous fluids and their uses. It provides details on the daily water and electrolyte requirements for adults and contents of common IV fluid preparations such as normal saline, D5NS, Ringer's lactate, and D5W. It describes the indications and contraindications for these fluids in various conditions like dehydration, diarrhea, vomiting, shock, renal failure, and hepatic failure. Hypokalemic hypochloremic alkalosis is discussed as a consequence of vomiting while diarrhea can cause hypokalemic hyperchloremic acidosis. Isotonic saline is recommended for gastric irrigation while oral rehydration solutions are suitable for diarrhea.

1. INTRAVENOUS FLUIDSINTRAVENOUS FLUIDS

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Blood Plasma Solutes :

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5. *
Water Input and Output of the “Normal” Adult
• Minimal Obligatory Daily Water input:
– Ingested water: 500mL
– Water content in food: 800mL
– Water from oxidation : 300mL
TOTAL: 1600mL
• Minimal Obligatory Daily water output:
Urine: 500mL
Skin: 500mL
Respiratory tract: 400mL
Stool: 200mL
TOTAL: 1600mL
→ Average adult input/output is 30-35mL/kg/day (2.4L/day)

6. Daily Electrolyte Requirements
• - Sodium: 100-250meq (western diet)
– mostly excreted in urine
• - Potassium: 50-100meq
– mostly excreted in urine, 5% in feces
• - Chloride: 60-150meq
– Example: 1/2NS @ 100cc/hr provides ~180mEq of sodium and chloride/day!
- this is why NS should not be used for maintenance fluid in patients
with normal renal function- risk of hyperchloremic metabolic acidosis
• - Bicarb: 1 meq/kg/day

7. Contents of IV Fluid Preparations
Na
(mEq/L)
K
(mEq/L)
Cl
(mEq/L)
HCO3
(mEq/L)
Dextrose
(gm/L)
mOsm/L
D5W 50 278
½ NS 77 77 143
D51/2NS 77 77 50 350
NS 154 154 286
D5NS 154 154 50 564
Ringers
Lactate (RL)
130 4 109 28 50 272

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Daily Requirement : 100 meq/day (Salt – NaCl = 6 gram/day)
Role : Normal activity of skeletal and cardiac activity
Serum normal Na = 140 meq/L
Sodium :Sodium :
Hyponatremia (135 <)
Complains :
Muscle cramps
Nausea
Lethargy
Drowsiness
Convulsions
Hypernatremia (145 >)
Source :
Papad
Tomato
Pickles
Chines food
1 gm NaCl = 17 meq Na

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Daily Requirement : 60 meq/day
Role : Normal activity of skeletal and cardiac activity
Normal K = 4.5 meq/L
Potassium :Potassium :
Hypokalemia (3.5 <)
Complains :
Constipation
Paralytic Ileus
Muscle weakness
Fatigue
Cardiac arrhythmia
Hyperkalemia (5.5 >)
Source :
Fruits – juices
dry fruits
Coca
Coconut water
Coffee

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Daily Requirement : 100 gms/day
Role : Normal activity
Dextrose :Dextrose :
Hypokalemia (3.5 <)
Complains :
Constipation
Paralytic Ileus
Muscle weakness
Fatigue
Cardiac arrhythmia
Hyperkalemia (5.5 >)
Source :
Fruits – juices
dry fruits
Coca
Coconut water
Coffee

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50 gm dextrose in 1 Lit
Hypotonic fluid
5% DNS :5% DNS :
Indications :
Dehydration
Hyprnatremia
Vehicle for IV drugs
Pre n post operative
fluids
Contra-Indications :
Cerebral odema
Head injury
Post neuro surgery
Hyponeatremia
Shock

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Most physiological and
balanced fluid
No Glucose
Na – 130 meq/L
K – 4 meq/L
Cl – 109 meq/L
Lactate – 28 (Bicarbonate)
Calcium – 3meq/L
RL :RL :
Indications :
Intra operative periods
Diarrhea
Burns
Contra-Indications :
Restrict in HT and anasarca
Liver failure
Shock
Sever hypoxia
Sever metabolic acidosis

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Isotonic Saline fluid
8.5 gm / L
No Glucose
NS :NS :
Indications :
Diarrhea
Vomiting
Excessive sweating
Hypovolamic shock
Metabolic alkalosis
Diabetic kitoacidosis
Hypercalcemia
Contra-Indications :
Renal failure
CHF
Cirrhosis of liver
Uncontrolled HT

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Loss of,
Water - Dehydration
Cl – Hypochlcimemia
H - Alkalosis
K – Hypokalemia
VOMITING :
Hypokalemic hypochloremic alkalosis
VOMITING :
Hypokalemic hypochloremic alkalosis
Rx:
 NS + Potassium suppliments
For stable patient Isolyte G

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Loss of,
Water - Dehydration
HCo3
K – Hypokalemia
DIARRHEA :
Hypokalemic hyperchloremic acidosis
DIARRHEA :
Hypokalemic hyperchloremic acidosis
Rx:
Oral ORS
IV RL/ Isotonic saline
Potassium and bicarbonate
supplements
ORT :
Home made ORS (40 gm
sugar + 4 gm salt)
Butter milk with salt and
sugar
Lemon sarbat
Coconut water
Dal pani
Thin rice kanji

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DIARRHEA :
Hypokalemic hyperchloremic acidosis
DIARRHEA :
Hypokalemic hyperchloremic acidosis
Rx should NOT give:
Plain water
Glucose water without salt
Salt without sugar
Tea
Sweetened drinks

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V & D = Isotonic saline

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GASTRIC IRRIGATION :GASTRIC IRRIGATION :
Rx:
Never use plain water
NS is ideal, no electrolyte so it draws gastric
secretions.
Also, water (1 L) + NaCl (8.5 gm)

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RENAL FAILURE :RENAL FAILURE :
Rx:
Isolyte MPG
RL
Na rich fluid

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HEPATIC FAILURE :HEPATIC FAILURE :
Avoid in Rx:
Isolyte G
RL

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SHOCK hypovolamic:SHOCK hypovolamic:
Avoid in Rx:
Isotonic saline (NS)
Colloid and blood
Never use 5% DNS and Isolytic in primary Rx

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