Intravenous Fluid Replacement Therapy

Creator: Dr. Simi Paknikar
Keywords: intravenous therapy, IV rehydration therapy, dehydration, intravenous therapy guidelines, IV replacement therapy

Author - Dr. Simi Paknikar, MD

Medically Reviewed by The Medindia Medical Review Team on Sep 19, 2015

What is Intravenous Fluid Replacement Therapy?

We often picture a patient in a hospital with a drip running by the side. The drip contains fluids and sometimes electrolytes that are administered directly into a vein.

Body fluids have a delicate balance of water and electrolytes like sodium, potassium, bicarbonate and chloride. Fluids are present within the blood vessels in the form of blood, as well as outside the blood vessels within cells and surrounding tissues. There are certain situations when excess water and electrolytes are lost from the body. These include burns, severe vomiting and diarrhea, or trauma where blood is lost. If the amount of fluids in the blood vessels is reduced, the kidneys and other organs can shut down. Therefore, there is an urgent need to replace fluids in the body. This fluid replacement is achieved by intravenous fluid therapy. Intravenous fluids are particularly necessary when there is a major loss of fluid or the patient cannot take in fluids orally. Cases of blood loss should be treated with blood transfusion; however, intravenous fluids may be administered till blood is made available.

Intravenous fluids are also administered when the balance between the water and electrolytes is lost. For example, if the sodium levels fall too low, intravenous fluid that contains sodium is given. If the potassium levels are low, a potassium-containing solution is administered.

Several drugs are also administered through IV fluids. These come either premixed with the fluid or have to be mixed before administration. It is important to note the instructions on the medication since some drugs cannot be given with certain IV fluids. Intravenous medications are particularly useful in emergencies because they act almost immediately.

Intravenous fluids are also used provide nutrition for those who cannot take in nutrition orally through a Ryles tube. They are administered during surgery to provide fluids and administer drugs.

What are the Types of Intravenous Fluids?

Intravenous fluids are of two types - crystalloids and colloids.

Crystalloids contain water, electrolytes and /or glucose in different proportions. Some of the crystalloids available include:

2.5%, 5%, 10% dextrose in water
Isotonic, hypertonic or hypotonic sodium chloride / saline
Dextrose in saline
Ringer lactate
Plasma-Lyte

Crystalloids are usually useful to replace extravascular fluids. They do increase blood volume, but their effect is temporary, hence they are used for fluid replacement for short-term purposes only. Fluids containing dextrose provide energy, while saline fluids contain sodium chloride in varying concentrations. Hypertonic saline contains high amounts of salt and can be given to people with low sodium levels. On the other hand, hypotonic saline is given in those with high sodium levels. A hypertonic solution also extracts the excessive fluid and reduces brain swelling in patients with a head injury. Ringer lactate and Plasma-Lyte contain electrolytes like sodium and potassium and resemble body fluids to a greater extent.

Examples of colloids are:

Hydroxyethyl starch
Dextran
Albumin

Colloids remain within blood vessels for a much longer time than crystalloids and help to increase the volume of fluid within blood vessels.

How is Intravenous Fluid Therapy Administered?

Intravenous fluids are usually administered in a hospital though they are also administered at home in some conditions. Some of the guidelines to administer intravenous fluid are as below:

The ideal fluid for the particular situation is selected
The amount of fluid necessary is calculated
The intravenous set is set up. The fluid is passed through the tubing to replace the air in it
The cannula for injection is introduced into a vein using aseptic precautions and secured in place. The injection is usually given in a peripheral vein in the arms or sometimes the legs. Irritant drugs cannot be administered into these veins. Injection into a larger vein closer to the heart is done in case long term IV fluids are required or the peripheral veins have collapsed
The drip rate of the IV set is adjusted
The IV fluid is labelled
The fluid level should be regularly monitored. The fluid intake and output should also be recorded

What are the Complications Associated with Intravenous Fluid Therapy?

Complications due to intravenous fluid therapy include:

Excess of fluid can result in fluid load. Due to this, the patient may suffer from pulmonary edema (fluid accumulation in the lungs) or heart failure
Infections, if adequate sterile precautions are not taken
Electrolyte imbalances, which can cause dangerous effects. For example, high potassium levels can affect the heart
Bleeding, pain and /or inflammation at the site of injection
Air embolism, if air goes through the tubing into the body. A clot may also be formed at the catheter site which can get detached and form an embolus. The embolus may travel to the heart or brain resulting in serious consequences
Allergic reaction to the fluid or drug administered

References:

Linton AD. Introduction to Medical-Surgical Nursing 6^th edition
Navarro LAC et al. Perioperative fluid therapy: a statement from the International Fluid Optimization Group. Navarro et al. Perioperative Medicine (2015) 4:3DOI 10.1186/s13741-015-0014-z
Marik PE et al. Hemodynamic parameters to guide fluid therapy. Marik et al. Annals of Intensive Care 2011, 1:1

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