4.4 Types of Fluids Required for Intravenous Therapy

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The general principles of fluid therapy in DHF include the following:

The following fluids are recommended both crystalloids and colloids

Crystalloids

  1. 0.9% NaCl (isotonic normal saline solution) (0.9% NS) (Preferable)
  2. 0.45% half strength normal saline solution (0.45% NS) (For children <6 months)
  3. 5% dextrose in lactated Ringer's solution (5% DRL)
  4. 5% dextrose in acetated Ringer's solution (5% DRA)
  5. Hartman solution (Preferable)

Colloids

  1. Plasmasol
  2. Dextran 40
  3. Human Albumin
  4. Plasma
  5. Hemaceel
  6. Blood & Blood Components

Ringer’s lactate is a safe, effective, and inexpensive alternative in initial resuscitation of patients with moderate shock. In patients with shock, dextran and starch perform similarly although repeated dextran 40 is associated with more hypersensitivity reactions.

Precautions

In order to ensure adequate fluid replacement and avoid fluid over infusion, the rate of intravenous fluid should be adjusted throughout the 24 to 48 hours period of plasma leakage by periodic HcT determinations and frequent assessment of vital signs.

The volume of fluid replacement should be just sufficient to maintain effective circulation during the period of plasma leakage.

Excessive fluid replacement and continuation for a longer period after cessation of leakage will cause respiratory distress from massive pleural effusion, ascites, and pulmonary congestion or edema. This may be dangerous.

Remember that 1 ml is equal to 15 drops in standard macro infusion set. In micro system (micro burette infusion set) 60 drops are equal to 1 ml.

  • It is advised to procure only a bag of 500 ml initially, and order more as and when required. The decision about the speed of fluid should be reviewed every 1-3 hours. The frequency of monitoring should be determined on the basis of the condition of the patient. The higher the flow rate the more frequent should be the monitoring.
  • It is needed to be careful about the adequacy of the fluid flow rate as high fluid flow rate may require appropriate adjustment of the fluid administration set, height of the saline stand and, sometimes positive pressure application by sphygmomanometer cuff around the fluid bag.