23/04/2025
1. Normal Saline (0.9% Sodium Chloride)
Type: Isotonic crystalloid
Used for:
Vomiting ( when associated with metabolic alkalosis due to gastric acid loss)
Mild to moderate dehydration
Hypovolemia and shock
Hyponatremia
Resuscitation (first-line for fluid boluses)
Fluid challenge in hypotensive patients
Compatible with blood transfusions and most IV medications.
Vomiting leads to loss of hydrogen and chloride ions (HCl), causing metabolic alkalosis. Normal Saline contains 154 mEq/L of chloride, which helps replace lost chloride and restore acid-base balance. It also lacks potassium and lactate, making it safer INITIALLY when electrolyte status is unknown, Ringer’s Lactate, contains potassium and lactate (a bicarbonate precursor)—not ideal for patients with alkalosis or impaired lactate metabolism (e.g., liver dysfunction).
Caution:
May cause hyperchloremic metabolic acidosis with prolonged use
Monitor for fluid overload, especially in renal or cardiac patients
Avoid large-volume use in patients with metabolic acidosis or hyperchloremia
2. Ringer’s Lactate (Lactated Ringer’s or RL)
Type: Isotonic
Used for:
Burns, trauma, or surgical procedures
Diarrhoea with electrolyte loss
Mild to moderate metabolic acidosis
Example: Often used in trauma patients needing both fluid and electrolyte replacement.
Avoid in: Liver disease, alkalosis, or hyperkalemia (contains potassium and lactate).
3. Dextrose 5% in Water (D5W)
Type: Isotonic (becomes hypotonic in the body)
Used for:
Hypoglycaemia
Hypernatremia (corrects sodium gradually)
Calorie and water source for NPO patients
Example: Given post-operatively to NPO patients for hydration and energy.
Not suitable for: Fluid resuscitation due to risk of hyponatremia.
4. Dextrose 10% in Water (D10W)
Type: Hypertonic
Used for:
Severe hypoglycaemia
Nutritional support when high-calorie glucose infusion is needed.
Example: Administered when patients on insulin infusions show signs of low blood sugar.
Caution: Requires central line for prolonged use due to vein irritation.
5. Half Normal Saline (0.45% NaCl)
Type: Hypotonic
Used for:
Cellular dehydration (e.g., diabetic ketoacidosis after initial resuscitation)
Hypernatremia
Example: Helps shift fluid into cells when sodium levels are high.
Avoid in: Head injury, increased ICP, burns, trauma (risk of cerebral oedema).
6. 3% Sodium Chloride (Hypertonic Saline)
Type: Hypertonic
Used for:
Severe or symptomatic hyponatremia
Cerebral oedema to reduce intracranial pressure
Example: ICU patients with brain injury and low sodium levels.
Caution: Risk of central pontine myelinolysis if corrected too rapidly—monitor sodium closely.
7. Dextrose 5% in 0.45% Sodium Chloride (D5½NS)
Type: Hypertonic
Used for:
Maintenance fluid with calories
Prevents hypoglycaemia in NPO patients
Example: Used for surgical patients requiring IV fluids and glucose.
Caution: Watch for fluid overload and hyperglycaemia.
8. Dextrose 5% in Normal Saline (D5NS)
Type: Hypertonic
Used for:
Post-operative fluid management
Sodium and calorie replacement
Example: Helps maintain energy balance and fluid status post abdominal surgery.
Caution: Not ideal for resuscitation in unstable patients.
9. Dextrose 5% in Ringer’s Lactate (D5RL)
Type: Hypertonic
Used for:
Caloric and electrolyte replacement after trauma or burns
Example: For patients needing continued support following initial resuscitation.
Caution: Avoid in renal failure and hyperglycaemic states.
10. Plasmalyte
Type: Isotonic, balanced crystalloid
Used for:
Resuscitation in trauma, sepsis, or surgery
Preferred in patients where acid–base balance is critical
Example: Alternative to RL for large-volume fluid replacement in surgery.
Note: Contains acetate and gluconate buffers for acid–base balance.
11. Albumin (5% or 25%)
Type: Colloid
Used for:
Hypoproteinemia, burns, liver cirrhosis with ascites
Hypovolemia with low oncotic pressure
Sepsis with hypoalbuminemia
Example: Given post-paracentesis in liver disease to prevent fluid shift.
Caution: Expensive and may not be superior to crystalloids for all patients.
12. Hetastarch (e.g., Hespan)
Type: Synthetic colloid
Used for:
Temporary volume expansion in shock or trauma
Example: Occasionally used in field settings or emergencies.
Caution: Associated with renal injury and coagulopathy; use is restricted in many settings.
13. Fresh Frozen Plasma (FFP)
Type: Blood product
Used for:
Bleeding due to coagulopathy
Warfarin reversal
Liver failure with active bleeding
Example: Pre-surgical correction of INR in patients on anticoagulants.
Caution: Requires ABO compatibility and close monitoring.
14. Total Parenteral Nutrition (TPN)
Type: Specialised IV nutrition
Used for:
Long-term NPO or malnourished patients
After major GI surgery, severe bowel obstruction, or short bowel syndrome
Example: Given via central line to a patient with severe Crohn’s disease and bowel resection.
Caution: Monitor for infection, hyperglycaemia, and liver dysfunction.
NOTE
Always assess the patient’s electrolyte status, renal function, and fluid balance before initiating IV therapy.
Hypertonic fluids require close monitoring and often a central line.
Hypotonic fluids are contraindicated in patients with brain injury or burns.
Watch for signs of fluid overload: oedema, crackles, shortness of breath, raised JVP.
Double-check compatibility when combining fluids with medications or blood products.
