luid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost

through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced
with oral rehydration therapy (drinking), intravenous therapy, rectally such as with a Murphy drip, or
by hypodermoclysis, the direct injection of fluid into the subcutaneous tissue. Fluids administered by
the oral and hypodermic routes are absorbed more slowly than those given intravenously.

Contents
[hide]

1Oral
2Intravenous
o 2.1Medical uses
o 2.2Types of fluids used
o 2.3Maintenance
o 2.4Procedure
3Other treatments
4See also
5References

Oral[edit]
Main article: Oral rehydration therapy
Oral rehydration therapy (ORT) is a simple treatment for dehydration associated with diarrhea,
particularly gastroenteritis/gastroenteropathy, such as that caused by cholera or rotavirus. ORT
consists of a solution of salts and sugars which is taken by mouth. For most mild to moderate
dehydration in children, the preferable treatment in an emergency department is ORT over
intravenous replacement of fluid.[1]
It is used around the world, but is most important in the developing world, where it saves millions of
children a year from death due to diarrheathe second leading cause of death in children under
five.[2]

Intravenous[edit]
Main article: Intravenous therapy

Medical uses[edit]
In severe dehydration, intravenous fluid replacement is preferred, and Daily requirements
may be lifesaving. It is especially useful where there is depletion of fluid Water 30 ml/kg/24 h
both in the intracellular space and the vascular spaces.
Na +
~ 1 mmol/kg/24 h
Fluid replacement is also indicated in fluid depletion due to
hemorrhage, extensive burns and excessive sweating (as from a K+ ~ 1 mmol/kg/24 h
prolonged fever), and prolonged diarrhea (cholera). Glucose 5 (3 to 8) g/hour
During surgical procedures, fluid requirement increases by increased
evaporation, fluid shifts and/or excessive urine production among other possible causes. Even a
small surgery may cause a loss of approx. 4 ml/kg/hour, and a large surgery approximately 8
ml/kg/hour, in addition to the basal fluid requirement.
The table to the right shows daily requirements for some major fluid components. If these cannot be
given enterally, they may need to be given entirely intravenously. If continued long-term (more than
approx. 2 days), a more complete regimen of total parenteral nutrition may be required.
Types of fluids used[edit]
The types of intravenous fluids used in fluid replacement are generally within the class of volume
expanders. Physiologic saline solution, or 0.9% sodium chloride solution, is often used because it
is isotonic, and therefore will not cause potentially dangerous fluid shifts. Also, if it is anticipated that
blood will be given, normal saline is used because it is the only fluid compatible with blood
administration.
Blood transfusion is the only approved fluid replacement capable of carrying oxygen; some oxygen-
carrying blood substitutes are under development.
Lactated Ringer's solution is another isotonic crystalloid solution and it is designed to match most
closely blood plasma. If given intravenously, isotonic crystalloid fluids will be distributed to the
intravascular and interstitial spaces.
Plasmalyte is another isotonic crystalloid.
Blood products, non-blood products and combinations are used in fluid replacement,
including colloid and crystalloid solutions. Colloids are increasingly used but they are more
expensive than crystalloids. A systematic review found no evidence that resuscitation with colloids,
instead of crystalloids, reduces the risk of death in patients with trauma, burns or following surgery.[3]

Maintenance[edit]
Maintenance fluids are used in those who are currently normally hydrated but unable to drink
enough to maintain this hydration. In children isotonic fluids are recommended for maintaining
hydration.[4]

Procedure[edit]
It is important to achieve a fluid status that is good enough to avoid low urine production. Low urine
output has various limits, but an output of 0.5 mL/kg/h in adults is usually considered adequate and
suggests adequate organ perfusion. The parkland formula is not perfect and fluid therapy will need
to be titrated to hemodynamic values and urine output.
The speed of fluid replacement may differ between procedures. The planning of fluid replacement
for burn patients is based on the Parkland formula (4mL Lactated Ringers X wt.in kg X % TBSA
burned= Amount of fluid ( in ml) to give over 24 hours). The Parkland formula gives the minimum
amount to be given in 24 hours. Half of the volume is given over the first eight hours after the time of
the burn (not from time of admission to ED) and the other half over the next 16 hours. In
dehydration, 2/3 of the deficit may be given in 4 hours, and the rest during approx. 20 hours.
The initial volume expansion period is called the fluid challenge, and may be distinguished from
succeeding maintenance administration of fluids.[5] During the fluid challenge, large amounts of fluids
may be administered over a short period of time under close monitoring to evaluate the patients
response.[5] Fluid challenge, as the procedure of giving large amounts of fluid in a short time, may be
reserved for hemodynamically unstable patients, distinguished from conventional fluid administration
for patients who are not acutely ill, who receive fluids as part of a diagnostic study, or for less acutely
ill patients in whom fluid administration can be guided by fluid intake and output recordings.[6]

Other treatments[edit]
Proctoclysis, an enema, is the administration of fluid into the rectum as a hydration therapy. It is
sometimes used for very ill persons with cancer.[7] The Murphy drip is a device by means of which
this treatment may be performed.

See also[edit]
 Hypodermoclysis
Intravenous therapy
Hypovolemia
Third spacing
Pentastarch
Passive leg raising test

References[edit]
1. Jump up^ "Ten Things Physicians and Patients Should Question", Choosing Wisely, American
College of Emergency Physicians, October 27, 2014 [October 14, 2013], retrieved April 6, 2015, which
cites:
Hartling, L; Bellemare, S; Wiebe, N; Russell, KF; et al. (2006). "Oral versus intravenous
rehydration for treating dehydration due to gastroenteritis in children". Cochrane Database of
Systematic Reviews (3): CD004390. doi:10.1002/14651858.CD004390.pub2. PMID 16856044.
2. Jump up^ The State of the Worlds Children 2008: Child Survival (PDF). UNICEF. December 2007.
p. 8. ISBN 9789280641912. Retrieved February 16, 2009.
3. Jump up^ Perel, P; Roberts, I (2011). "Colloids versus crystalloids for fluid resuscitation in critically ill
patients". Cochrane Database of Systematic Reviews (3):
CD000567. doi:10.1002/14651858.CD000567.pub4. PMID 21412866.[needs update]
4. Jump up^ McNab, S; Ware, RS; Neville, KA; Choong, K; et al. (2014). "Isotonic versus hypotonic
solutions for maintenance intravenous fluid administration in children". Cochrane Database of
Systematic Reviews (12): CD009457. doi:10.1002/14651858.CD009457.pub2. PMID 25519949.
5. ^ Jump up to:a b "Treat hypotension and/or elevated lactate with fluids". Surviving Sepsis Campaign.
Archived from the original on June 28, 2010. Retrieved August 2010. Check date values
in: |access-date= (help)
6. Jump up^ Vincent, J; Weil, M (2006). "Fluid challenge revisited". Critical Care Medicine. 34 (5):
13337. doi:10.1097/01.CCM.0000214677.76535.A5. PMID 16557164.
7. Jump up^ Bruera, E; Pruvost, M; Schoeller, T; Montejo, G; et al. (April 1998). "Proctoclysis for
hydration of terminally ill cancer patients". Journal of Pain and Symptom Management. 15 (4): 216
9. doi:10.1016/s0885-3924(97)00367-9. PMID 9601155.