![]() Your physician or other qualified health care provider should be contacted with any questions you may have regarding a medical condition. Although the editors have made every effort to provide the most up-to-date evidence-based medical information, this writing should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations.įor the Public: This writing is not intended to be a substitute for professional medical advice, diagnosis, or treatment. LEGAL DISCLAIMER ( to make sure that we are all clear about this): The information on this website and podcasts are the opinions of the authors solely.įor Health Care Practitioners: This writing is provided only for medical education purposes. As with the maintenance volume, the electrolyte composition should be tailored for the individual and monitored closely. ![]() Using Isotonic Fluids for Maintenance has proven to be safe, while Hypotonic Fluids have greater risk for hyponatremia.This is especially true for pre/post-operative patients or patient in whom there is risk for them having elevated ADH levels (so, like all of the ones who need an IV in the hospital).Favor Isotonic Fluids for Maintenance initially!.If giving fluids, realize that 4-2-1 rule is a starting point for maintenance volume… monitor urine output and tailor calculations for the individual.Ask yourself whether you actually need the IV fluids in the first place!.Iatrogenic fluid and electrolyte derangements are a significant hazard of intravenous fluids.Original, theoretical assumptions may be correct in theory, but in practice, the system is more complex.Medications (ex, opiates, SSRIs, NSAIDs, Phenothiazines).ADH secretion is stimulated by numerous factors and clinical states, like:.Elevated ADH will lead to less free water excretion and, thus, the hypotonic maintenance fluids will generate hyponatremia.One significant confounder in this system is Anti-Diuretic Hormone (ADH).Naturally, ¼ NS and ½ NS have been used for decades and not every patient is becoming hyponatremic and the rationale described originally is still valid, so it is obviously more complicated.Maintenance Fluids: Don’t Underestimate ADH’s Power Unfortunately, we know that hypotonic maintenance fluids are associated with greater risk for hyponatremia.Often this leads to prescribing ¼ NS or ½ NS (which, by the math, makes sense).Simple math will generate recommendations for both volume and tonicity of the maintenance fluids.Electrolytes need to be added to maintenance fluids based on energy expenditure as well:.The daily maintenance calculation is based on the same rationale, but generates slightly different hourly rates (nothing is perfect).2 ml/kg/hr for every kg between 10-20 kg, then additional….4 mL/kg/hr for first 10 kg, then additional….This is the basis of the “4-2-1” rule for determination of volume.For every 100 calories burned, there is ~100 mL of water lost.Caloric expenditure for the average child can be based on body weight.Holliday & Segar helped describe the rationale for this process in 1957:.Maintenance fluids are calculated based on expected energy expenditure. ![]() ![]() ![]()
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