IV Fluids and Fluid Balance: cram pack

Formula sheets, the key method steps for every topic and 4 practice problems, with full solutions at the back.

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1Formulas and methods

IV fluids & fluid balance

Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

2Practice problems

1.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjelly100 mLjuice150 mLice chips100 mLIV infusion100 mL/h × 12 hIV antibiotic2 × 50 mLurine325 mLurine250 mLwound drain150 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

jelly: 100 mLjuice: 150 mLice chips: 100 mLIV infusion: 100 mL/h × 12 hIV antibiotic: 2 × 50 mLurine: 325 mLurine: 250 mLwound drain: 150 mL
B = mL
2.IV fluids & fluid balanceHard
1000 mL50 mL/hstart 11:4513:45: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 11:45 and runs by pump at 50 mL/h. How many mL V are left in the bag at 13:45?

1000 mL50 mL/h11:45 → 13:45
V = mL
3.IV infusion ratesMedium
15 gtt/mL80 mL/h? gtt/min

An infusion is ordered at 80 mL/h, but no pump is available. It runs by gravity through a giving set of 15 gtt/mL. Find the drip rate R in drops per minute.

80 mL/h15 gtt/mL
R = gtt/min
4.IV infusion ratesHard
250 mg500 mL10 mL/h? mg/h

A bag contains 250 mg of a drug in 500 mL and runs at 10 mL/h. How many milligrams per hour D does the patient receive?

250 mg/500 mL10 mL/h
D = mg/h

3Solutions

1.IV fluids & fluid balance

Answer: B = 875 mL

Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Total intake

oral: 100 + 150 = 250 mL
ice chips: 100/2 = 50 mL
IV infusion: 100·12 = 1200 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1600 mL

Total output

325 + 250 + 150 = 725 mL

Balance

B = 1600 − 725 = 875 mL

Answer

B = 875 mL

Positive: more fluid went in than came out.

2.IV fluids & fluid balance

Answer: V = 900 mL

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Elapsed time

11:45 → 13:45 = 2 h

Volume infused

50·2 = 100 mL

Volume left

V = 1000 − 100 = 900 mL

Answer

V = 900 mL
3.IV infusion rates

Answer: R = 20 gtt/min

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Millilitres per minute

80/60 = 1.333 mL/min

Drip rate

R = 1.333·15 = 20 gtt/min

Answer

R = 20 gtt/min
4.IV infusion rates

Answer: D = 5 mg/h

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Concentration

250/500 = 0.5 mg/mL

Dose rate

D = 0.5·10 = 5 mg/h

Answer

D = 5 mg/h

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