Monday 8 May, 2006

Index: Intravenous fluid therapy

Posted in Best Topics, Michael Tam at 21:45 by Michael Tam

Original article by: Michael Tam

This is an index page linking a series of articles on intravenous fluids.

Intravenous fluid therapy is the most common “prescription” written by a junior doctor. Paradoxically, however, it is a relatively poorly taught subject with most interns (very quickly) learning on the job. It is common to see the practice of simply “copying the last order”.

When I went through medical school, fluid management was taught – but from a physiological point of view and then by a renal physician. The first was enlightening though not easily translated into clinical practice. The second was simply above my level. And thus in clinical practice, I noticed initially in both myself and my peers that we had a reasonable grounding in fluid physiology but when it came to writing fluid orders on the run, they were based more on art than science… “my gut tells me that the next bag needs to run faster”. Sometimes we were right. Other times it did not matter. At times we were very wrong.

The following is a list of articles that give a practical overview on how to order and use intravenous fluids in most common settings.

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8 Comments »

  1. upul jhj said,

    best one

  2. Lyndsey said,

    THANK YOU!! I have been trying so long to get somebody to expain fluids to me just like this!!

    Thank you!!

  3. meghal said,

    thanks a lot…
    simplicity personified…
    very good understanding bestowed on us..
    thanks again..

  4. pradeep said,

    hi sir please help me to get review of literature regarding nursing care of intravenous therapy for my research studies ….

  5. David said,

    Hi my name is David. I am a final year medical student. i start internship in 2 months and i just came accross your website. I just want to say, it is absolutely unbelievable. These are all the topics that i am stressed about not knowing when i start internship and you have made them really succinct and inspiring to read. Thank you so much.

    I have a question in regards to fluids.

    In a euvolemic adult who requires maintenance fluids, if you need to give it slowly (i.e heart/liver/renal failure / hypernatraemia etc), if you decrease the fluid rate from lets say 8 hourly to 16 hourly, will they get adequate sodium and potassium? If not, do you add more to the regimen, or just keep the calculated maintenance ratios the same as for 8 hourly and just give it over 16 hours? I realise if they have renal failure, they will retain more K+ anyway but what about the other causal factors?

    I really appreciate your time.

    Thanks so much,

    David.

  6. Michael Tam said,

    It is not so simple. Basically, you’ll need to go back to first principles:
    (1) Work out the quantity of water needed
    (2) Work out the amount of sodium and potassium required
    (3) Convert that into premixed bags of fluid where possible.

    Congratulations on your coming graduation and best of luck in your internship!

    Cheers.

  7. David said,

    Thanks so much for that quick reply.

    Are we able to donate to your website? Its an amazing thing what you are doing!

  8. MAX said,

    could you tell me about fluid management in CHF or other hypervolemic patients


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