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How much would a liter of fluid hemodilute labs?

Has 2 years experience.

Boy, this is getting old. I swear every. single. day. I am having to look up stuff I didn't learn in school and can't find in a book.

If you have a pt that comes in with a possible GI bleed, positive occult blood, and low hgb. Pt gets a liter of fluid per sepsis guidelines. (Admitted for UTI.) How much would you expect that liter to drop the hemoglobin?

How much have you seen a liter of fluid running at 150/hr drop someone's hemoglobin? I'm trying to get some perspective on what type of drop in hgb I should expect to see?

What was the initial hemoglobin and then the repeat value and the length of time between the two? Anytime I've seen a HUGE drop it was either a huge GI bleed, not a fluid issue, or the blood from the lab draw was diluted because it was drawn from above the IV site. But that's from my ER experience, which is limited by time, since we typically isn't have patients for an extended period of time (hopefully).

Okami_CCRN, ADN, RN

Specializes in Critical Care. Has 4 years experience.

A liter of fluid infusing at 150ml/hr should not dilute labs tremendously, If the patient dropped a gram or more I would be concerned they were bleeding. Also what was their initial hemoglobin, length of time since last CBC, did they receive PRBC's, all to take into consideration.

I had a patient whose Hgb was 15g/dl admitted for DKA, after 5 liter boluses within a few hours I had lab calling me asking for a re-draw because his Hgb was 12g/dl. I'm pretty sure that result was due to dilution, hope that puts it into perspective.

tsm007

Has 2 years experience.

What was the initial hemoglobin and then the repeat value and the length of time between the two? Anytime I've seen a HUGE drop it was either a huge GI bleed, not a fluid issue, or the blood from the lab draw was diluted because it was drawn from above the IV site. But that's from my ER experience, which is limited by time, since we typically isn't have patients for an extended period of time (hopefully).

Initial hgb was 8, recheck hgb was 6.5. I was concerned about a GI bleed with a positive occult blood, but 2 of the nurses I worked with thought the drop was likely caused by the fluids. I don't have as much experience so I am trying to get better perspective on how much I should expect hgb to drop. Pt did wind up getting a transfusion. I just want to know for the future to know how much I should expect it to drop and what kind of drop would be "expected". I think that 6.5 was going to require treatment regardless.

tsm007

Has 2 years experience.

A liter of fluid infusing at 150ml/hr should not dilute labs tremendously, If the patient dropped a gram or more I would be concerned they were bleeding. Also what was their initial hemoglobin, length of time since last CBC, did they receive PRBC's, all to take into consideration.

I had a patient whose Hgb was 15g/dl admitted for DKA, after 5 liter boluses within a few hours I had lab calling me asking for a re-draw because his Hgb was 12g/dl. I'm pretty sure that result was due to dilution, hope that puts it into perspective.

8 at around 6pm, 6.5 around 6am. I do not have access to any other lab results since I'm at home now. I think that was too big of a drop, but not sure what would be an expected drop, 7.5? 7?

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