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Paucis Verbis: Composition of intravenous fluids

Posted Jan 03 2013 12:00am

There has been a lot of discussion on the ideal intravenous fluid (IVF) for resuscitation in the Emergency Department and ICU. This was highlighted by the landmark study in JAMA on ICU patients who received chloride-rich versus chloride-restricted IVFs.

This got me to thinking, what exactly comprises the common IVFs that we order? We so often take for granted what's in 1 liter of normal saline. As it turns out, normal saline is not really "normal". Dr. Scott Weingart has a great podcast on "chloride poisoning" using IVFs.

This PV card helps remind me what's in each liter bag of fluids we order. At the bottom half of the card is a brief summary of the JAMA findings.

Feel free to download this card and print on a 4'' x 6'' index card.
[ MS Word ] [ PDF ]See  other Paucis Verbis cards .
Update 1/4/13: After the posting of this PV card, there was intense discussion about why the D5W osmolarity was 252 mOsm/L instead of 272 mOsm/L, which is found on various medical calculators. See the discussion by Dr. Joel Topf.

@ kidney_boy @ m_lin @ brianjl @ pharmertoxguy Great story.It's not what we know/don't know, it's what we don't know that we don't know.
— David Y.T. Chen (@dytcmd) January 4, 2013

Has this JAMA study and ongoing discussions of fluid content changed your approach to ED fluid management? 

It sure has for me. After 2 liters of normal saline, I consider switching patients to a more chloride-restrictive fluid (we have Plasma-Lyte in our ED). Examples include patients with DKA, AKA, sepsis, and severe dehydration.

Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012 Oct 17;308(15):1566-72. PubMed PMID: 23073953 .
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