I have a burning questions and cannot seem to find any literature that answers it for me in my own research.
What is the indication for IV fluids in a patient that does not seem to need them? I'm not talking about your nausea, vomiting, fevers, etc. I understand that. However in the ER we seem to give fluids to almost everyone and I can't figure out why. I asked a PA and the answer I got was "everyone likes fluids!"
I like to be able to explain the treatment modality to the patient. It's easy to do when they have been vomiting or have a fever, but sometimes I can't figure out why were ordered at all!
Examples might be a diagnosis of general weakness in a 30 year old, no PMHx and perfectly normal labs. What's the purpose? No evidence of dehydration. No vomiting. Why the fluids?
Another example may be a trip and fall in a 70 year old, no LOC, only orders are for scans without contrast. Why the fluids?
I know it might sound dumb, but I'm just curious why almost anyone that comes through the ER doors gets a liter, unless they are a true level 5, like a dental pain or work note!
This drives me up the wall. A large majority of people who get fluids have no indication at all. One could certainly argue that many patients should have a lock placed, preferably with labs, but there is really no reason to give fluids in many cases. Actually, as someone mentioned above, giving saline for no good reason is just as likely to harm as to hurt (think decreased hgb from dilution, vasculitis or the rare but very bad endocarditis.)
As far as the "most people are a little dehydrated" argument, sorry but it doesn't fly with me. It may be true but a liter of fluids is a very temporary band aid and actually may just discourage the person from building healthier habits-after all if they feel a little off they can just run off to the hospital for IV fluids! Plus the above mentioned risks which are small bit significant since there is almost no real benefit.
I think it satisfies the "worried well" and attention seekers who come in with asymptomatic "low blood pressure" of 100/60 in a 25 year old or show up saying they momentarily felt a little dizzy when getting out of bed yesterday morning. I've seen many of these discharged home (because there is nothing wrong with them) only to return again and again "until they do something for me." And now the pt can text all their friends about how they were SO SICK that they needed an IV!!!!
The reason it bothers me is aside from the cost and risk and slowing pt flow, it reinforces people running to the hospital for minor complaints (i needed an IV last time so i better go in again) and encourages them to continue bad habits (pt is nauseated but can tolerate po but doesn't make any effort to hydrate themselves because they think ivf is the answer. )
Our trauma service has gone to PlasmaLyte exclusively and pulmonary/critical care services are moving in that direction.
Normosol is the same stuff as Plasmalyte and the sooner NS is abandoned the better, IMHO...LR is OK for one or two liters, but after that, or better yet from the get go....Plasmalyte/Normosol
In my CT anesthesia practice I hang Normosol for any moderate to large volume loss case.
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bgxyrnf, MSN, RN
1,208 Posts