IV Fluids & Blood Products
Crystalloids, colloids, blood products, massive transfusion protocol, and fluid calculators
Osmolality: 308 mOsm/L (isotonic) | pH: 5.0
Indications
- ✓ Volume resuscitation (first-line for most situations)
- ✓ Hyponatremia correction
- ✓ Diabetic ketoacidosis (initial resuscitation)
- ✓ Hypochloremic metabolic alkalosis
- ✓ Drug dilution and IV medication administration
- ✓ Blood product compatibility (only crystalloid compatible with blood)
Contraindications
- ✗ Hypernatremia
- ✗ Fluid overload / decompensated heart failure
- ✗ Hyperchloremic metabolic acidosis (use balanced crystalloid instead)
250-1000 mL bolus for resuscitation. Maintenance: 125 mL/hour (adjust to clinical need).
Bolus: 250-500 mL over 15-30 min. Maintenance: 80-125 mL/hour. Resuscitation: up to 1 L over 15 min.
- ⚠ Large volumes cause hyperchloremic metabolic acidosis (HAGMA)
- ⚠ Only 25% remains intravascular after 1 hour
- ⚠ Risk of fluid overload in cardiac and renal patients
- ⚠ Only crystalloid compatible with blood transfusion
Osmolality: 273 mOsm/L (slightly hypotonic) | pH: 6.5
Indications
- ✓ Volume resuscitation (preferred over NS in most situations)
- ✓ Surgical fluid replacement
- ✓ Trauma resuscitation
- ✓ Burns resuscitation (Parkland formula)
- ✓ Sepsis resuscitation
- ✓ General maintenance fluids
Contraindications
- ✗ Hyperkalemia (contains 5 mEq/L K+)
- ✗ Severe hepatic failure (impaired lactate metabolism)
- ✗ NOT compatible with blood products (calcium causes clotting)
- ✗ Traumatic brain injury (slightly hypotonic - risk of cerebral edema)
250-1000 mL bolus for resuscitation. Maintenance: 125 mL/hour.
Bolus: 250-500 mL over 15-30 min. Maintenance: 80-125 mL/hour.
- ⚠ Contains potassium - avoid in hyperkalemia and renal failure
- ⚠ Contains calcium - NOT compatible with blood products or ceftriaxone
- ⚠ Lactate is metabolized to bicarbonate by the liver
- ⚠ Slightly hypotonic - caution in TBI (use NS instead)
Osmolality: 294 mOsm/L (isotonic) | pH: 7.4
Indications
- ✓ Volume resuscitation (most physiological crystalloid)
- ✓ Preferred in renal failure (no lactate, physiological pH)
- ✓ Preferred in hepatic failure (acetate instead of lactate)
- ✓ Diabetic ketoacidosis (after initial NS)
- ✓ Perioperative fluid management
Contraindications
- ✗ Hyperkalemia (contains 5 mEq/L K+)
- ✗ Severe hypermagnesemia
250-1000 mL bolus for resuscitation. Maintenance: 125 mL/hour.
Bolus: 250-500 mL over 15-30 min. Maintenance: 80-125 mL/hour.
- ⚠ Contains potassium - avoid in hyperkalemia
- ⚠ More expensive than NS or Hartmann's
- ⚠ Acetate and gluconate metabolized to bicarbonate
Osmolality: 252 mOsm/L | pH: 4.0
Indications
- ✓ Free water replacement (hypernatremia correction)
- ✓ Hypoglycemia treatment (mild)
- ✓ Drug dilution vehicle
- ✓ Maintenance fluids (with electrolyte additives)
Contraindications
- ✗ Volume resuscitation (no electrolytes, distributes to total body water)
- ✗ Cerebral edema / raised ICP
- ✗ Hyponatremia (worsens it)
- ✗ Diabetic ketoacidosis (hyperglycemia)
Hypernatremia: 150-250 mL/hour (adjust based on Na correction rate).
Maintenance: 80-125 mL/hour. Hypernatremia correction: 150-250 mL/hour.
- ⚠ Provides only free water - NO volume expansion
- ⚠ Dextrose is rapidly metabolized, leaving free water
- ⚠ Can worsen hyponatremia and cerebral edema
- ⚠ Not for volume resuscitation
Osmolality: 154 mOsm/L (hypotonic) | pH: 5.0
Indications
- ✓ Hypernatremia correction (with or without dextrose)
- ✓ Maintenance fluids (with KCl added)
- ✓ DKA maintenance (after initial NS resuscitation)
Contraindications
- ✗ Volume resuscitation
- ✗ Hyponatremia
- ✗ Cerebral edema / raised ICP
Maintenance: 80-125 mL/hour. Hypernatremia: adjust to correction rate.
80-250 mL/hour depending on indication.
- ⚠ Hypotonic - can cause cerebral edema if given too rapidly
- ⚠ Not for volume resuscitation
- ⚠ Often given as 0.45% NaCl + 5% Dextrose (D5 half-NS)
Osmolality: 1026 mOsm/L (hypertonic) | pH: 5.0
Indications
- ✓ Symptomatic severe hyponatremia (seizures, coma)
- ✓ Cerebral edema / raised ICP (alternative to mannitol)
- ✓ Traumatic brain injury (osmotherapy)
Contraindications
- ✗ Hypernatremia
- ✗ Fluid overload
- ✗ Chronic hyponatremia without symptoms (risk of ODS)
Hyponatremia: 100-150 mL bolus over 10-20 min (can repeat x2). Infusion: 15-30 mL/hour.
Bolus: 100-150 mL over 10-20 min. Infusion: 15-30 mL/hour. Max correction: 8 mEq/L per 24 hours.
- ⚠ CENTRAL LINE PREFERRED (irritating to peripheral veins)
- ⚠ Rapid correction of chronic hyponatremia causes osmotic demyelination syndrome (ODS)
- ⚠ Max correction: 8 mEq/L in 24 hours (6 mEq/L if high-risk for ODS)
- ⚠ Monitor serum Na Q1-2H during infusion
Osmolality: 1098 mOsm/L (hypertonic) | pH: 5.0-7.0
Indications
- ✓ Raised intracranial pressure (ICP)
- ✓ Cerebral edema
- ✓ Acute angle-closure glaucoma
- ✓ Forced diuresis (rhabdomyolysis)
Contraindications
- ✗ Anuria / severe renal failure
- ✗ Severe dehydration
- ✗ Active intracranial bleeding
- ✗ Pulmonary edema
Raised ICP: 0.25-1 g/kg IV over 15-20 minutes. Can repeat Q4-6H.
0.25-1 g/kg over 15-20 minutes via filter set.
- ⚠ Must use in-line filter (crystals can form)
- ⚠ Monitor serum osmolality (hold if >320 mOsm/L)
- ⚠ Can cause rebound ICP elevation
- ⚠ Causes osmotic diuresis - replace fluids
- ⚠ Check renal function before each dose