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
IntakeOutput12-hour shifttea200 mLwater240 mLsoup180 mLice chips100 mLIV infusion125 mL/h × 12 hIV antibiotic2 × 100 mLurine250 mLurine300 mLurine200 mLurine300 mLwound drain50 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.

tea: 200 mLwater: 240 mLsoup: 180 mLice chips: 100 mLIV infusion: 125 mL/h × 12 hIV antibiotic: 2 × 100 mLurine: 250 mLurine: 300 mLurine: 200 mLurine: 300 mLwound drain: 50 mL
B = mL
2.IV fluids & fluid balanceHard
1000 mL250 mL infused125 mL/h12:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 125 mL/h. At 12:00, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

1000 mL250 mL infused125 mL/h
t = h
3.IV infusion ratesMedium
810 mLleft? mL/h7 h left

1000 mL was ordered over 10 hours. After 3 hours you find that 810 mL is still in the bag, and the order must still finish on time. To what rate R in mL/h must the pump be reset?

1000 mL / 10 hafter 3 h: 810 mL
R = mL/h
4.IV infusion ratesHard
100 mg500 mL15 mL/h? mg/h

A bag contains 100 mg of a drug in 500 mL and runs at 15 mL/h. How many milligrams per hour D does the patient receive?

100 mg/500 mL15 mL/h
D = mg/h

3Solutions

1.IV fluids & fluid balance

Answer: B = 1270 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: 200 + 240 + 180 = 620 mL
ice chips: 100/2 = 50 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 2·100 = 200 mL
total intake = 2370 mL

Total output

250 + 300 + 200 + 300 + 50 = 1100 mL

Balance

B = 2370 − 1100 = 1270 mL

Answer

B = 1270 mL

Positive: more fluid went in than came out.

2.IV fluids & fluid balance

Answer: t = 6 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

1000 − 250 = 750 mL

Time

t = 750/125 = 6 h

Answer

t = 6 h

That is about 6 h 00 min, so the bag runs out at about 18:00.

3.IV infusion rates

Answer: R = 115.7 mL/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.

Original rate

1000/10 = 100 mL/h

New rate

R = 810/7 = 115.7 mL/h

Answer

R = 115.7 mL/h

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

4.IV infusion rates

Answer: D = 3 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

100/500 = 0.2 mg/mL

Dose rate

D = 0.2·15 = 3 mg/h

Answer

D = 3 mg/h

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