Intravenous fluids

Take home messages

• Decide if you're resuscitating or maintaining
• Review what impact your fluids are having
• Don't give colloids

Crystalloids

Crystalloids are water-based solutions with added solutes (electrolytes or glucose). They differ in their composition, which determines their distribution throughout the body.

• Glucose effectively becomes free body water (i.e. not limited to the extracellular space) and so is not suitable for fluid resuscitation
• 'Normal’ Saline and ‘Balanced’ Crystalloids (such as Plasmalyte) are retained in the extracellular spaces (in plasma and the interstitium) and so are much more suitable for fluid resuscitation

Normal Saline

5% Dextrose

Plasmalyte

Hartmann’s Solution

4% Glucose with 0.18% NaCl

Colloids

Colloids have been popular for their use as plasma volume expanders. This is because they are 100% retained within the intravascular space (at least initially). They are a crystalloid base with added colloid substance that does not freely diffuse across cell membranes. 

For various reasons, their use has fallen out of favour.

However, you should be aware of their chemical classification and the pros and cons associated with each. 

Human Albumin Solution

Starches

Dextrans

Gelatins

Our videos

Useful Tweets and resources

IV Fluid Guidance – don’t drown in confusion!

IV fluid policy Written by: Dr Jonny Wilkinson– Consultant in ITU and Anaesthesia and NICE IV Fluid Lead Dr Lisa Yates – Clinical Fellow in ITU Additions from Dr Ashley Miller (@icmteaching). …

Critical Care NorthamptonView all posts by Jonny Wilkinson

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