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Discussion

fluid replacement

can someone please tell me if they know of a web site where i can get help on determining hourly flow rates on maintaining fluid replacement by kg's?

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i don't know of a website, but i posted information on this from my iv therapy textbook from 1995 on post #2 of this thread:

this is what is posted:

this information is coming from page 477 of intravenous therapy: clinical principles and practice, by judy terry, leslie baranowski, rose anne lonsway and carolyn hedrick, published by the intravenous nurses society, 1995.

isotonic fluid volume deficit

type of loss
: solute and water loss proportional, no change in plasma volume, serum sodium level is decreased to 125-150 meq/l. the cause of the fluid loss is gi fluid loss, urine loss and decreased oral intake.

clinical signs
: poor skin turgor; cold, dry dusky skin; sunken eyes; dry mucous membranes; depressed fontanelles in babies; rapid pulse; low b/p; irritability or lethargy

fluid replacement guidelines
: initially, a bolus of 0.9% sodium chloride or ringer's lactate is given followed by 5% dextrose in water and 0.45% sodium chloride. half of the deficit should be replaced in the first 8 hours and the remaining half over the next 16 hours

hypotonic fluid volume deficit

type of loss
: more solute is lost than water. plasma volume moves from the ecf to the icf. serum sodium levels are decreased below 125 meq/l. the cause of the fluid loss is often a gi fluid loss with hypotonic oral intake.

clinical signs:
include very poor skin turgor; cold, clammy, dusky skin; sunken eyes; slightly dry mucous membranes; depressed fontanelles in babies; rapid pulse; very low blood pressure; lethargy; coma; seizures

fluid replacement guidelines:
initially a bolus of 0.9% sodium chloride or ringer's lactate followed by 5% dextrose in water and 0.9% sodium chloride. if the patient is severely symptomatic 3% sodium chloride at 4ml/kg should be given over 10 minutes with close monitoring. half of the fluid deficit should be replaced in the first 8 hours and the remaining half over the next 16 hours.

hypertonic fluid volume deficit

type of loss
: there is greater water loss than solute loss. volume moves from the icf to the ecf. sodium levels are maintained at over 150 meq/l. the cause is gi fluid loss with hypertonic oral intake, diabetes insipidus, fever and hyperventilation.

clinical signs
: include fair skin turgor; cold, thick and doughy skin; sunken eyes; parched mouth; depressed fontanelles in babies; a moderately rapid pulse; moderately low blood pressure; hyperirritability; high-pitched crying in babies; seizures.

fluid replacement guidelines:
5% dextrose in water and 0.225% or 0.45% sodium chloride. if the patient is hypertensive 0.9% sodium chloride or ringer's lactate should be given at a rate of 20ml/kg over one hour. fluid replacement should be given slow and gradual over 48 hours. 2 to 3 meq/kg of potassium should be given per 24 hours. at least 2 meq/l/hour of sodium should also be included in the iv fluids that are used.

hope that helps and is what you are looking for.

I don't quite understand the question. Fluid replacement depends on the situation In the first 24 hours of a patient sustaining burn injuries they could get upwards of 10-20 liters of fluid and then for other situations they may just require a heplock. CHF wouldn't get a great deal of fluid, but someone with rhabdomyolosis may have their IVf titrated to keep their urine output up. Is there a particular situation that you're talking about?

Just had a thought ... 1L of fluid = 1kg = 2.2lbs ... is that what you're looking for?

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