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.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

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
IntakeOutput8-hour shiftwater120 mLjelly120 mLjuice100 mLIV infusion100 mL/h × 8 hIV antibiotic1 × 100 mLurine150 mLurine275 mLurine350 mLwound drain130 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The patient weighs 47 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

47 kg8 hurine: 150 mLurine: 275 mLurine: 350 mLwound drain: 130 mL
U = mL/kg/h
2.IV fluids & fluid balanceHard
500 mL300 mL infused100 mL/h09:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 100 mL/h. At 09:00, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL300 mL infused100 mL/h
t = h
3.IV infusion ratesMedium
250 mL60 gtt/mL5 h? gtt/min

Infuse 250 mL over 5 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

250 mL5 h60 gtt/mL
R = gtt/min
4.IV infusion ratesHard
760 mLleft? mL/h8 h left

1000 mL was ordered over 12 hours. After 4 hours you find that 760 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

1000 mL / 12 hafter 4 h: 760 mL
Δ = %

3Solutions

1.IV fluids & fluid balance

Answer: U = 2.06 mL/kg/h

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 urine

150 + 275 + 350 = 775 mL

Per kilogram per hour

U = 775/(47·8) = 2.061 ≈ 2.06 mL/kg/h

Answer

U = 2.06 mL/kg/h
2.IV fluids & fluid balance

Answer: t = 2 h

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.

Volume left

500 − 300 = 200 mL

Time

t = 200/100 = 2 h

Answer

t = 2 h

That is about 2 h 00 min, so the bag runs out at about 11:00.

3.IV infusion rates

Answer: R = 50 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.

Time in minutes

5·60 = 300 min

Drip rate

R = 250·60/300 = 50 gtt/min

Answer

R = 50 gtt/min
4.IV infusion rates

Answer: Δ = 14 %

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.

Original rate

1000/12 = 83.33 mL/h

New rate

R = 760/8 = 95 mL/h

Percentage change

Δ = (95 − 83.33)/83.33·100% = 14%

Answer

Δ = 14%

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

ExamProblems · examproblems.com/courses/iv-fluids-and-fluid-balance