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 shiftwater150 mLjuice100 mLIV infusion50 mL/h × 12 hIV antibiotic1 × 50 mLurine275 mLurine475 mLurine475 mLwound drain100 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).

water: 150 mLjuice: 100 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 1 × 50 mLurine: 275 mLurine: 475 mLurine: 475 mLwound drain: 100 mL
B = mL
2.IV fluids & fluid balanceHard
1000 mL350 mL infused60 mL/h15:30t = ? h

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 60 mL/h. At 15:30, 350 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

1000 mL350 mL infused60 mL/h
t = h
3.IV infusion ratesMedium
20 gtt/mL75 mL/h? gtt/min

An infusion is ordered at 75 mL/h, but no pump is available. It runs by gravity through a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.

75 mL/h20 gtt/mL
R = gtt/min
4.IV infusion ratesHard
350 mLleft? mL/h5 h left

500 mL was ordered over 8 hours. After 3 hours you find that 350 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?

500 mL / 8 hafter 3 h: 350 mL
Δ = %

3Solutions

1.IV fluids & fluid balance

Answer: B = −425 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: 150 + 100 = 250 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 1·50 = 50 mL
total intake = 900 mL

Total output

275 + 475 + 475 + 100 = 1325 mL

Balance

B = 900 − 1325 = −425 mL

Answer

B = −425 mL

Negative: the patient lost more fluid than went in.

2.IV fluids & fluid balance

Answer: t = 10.8 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 − 350 = 650 mL

Time

t = 650/60 = 10.83 ≈ 10.8 h

Answer

t = 10.8 h

That is about 10 h 50 min, so the bag runs out at about 02:20.

3.IV infusion rates

Answer: R = 25 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

75/60 = 1.25 mL/min

Drip rate

R = 1.25·20 = 25 gtt/min

Answer

R = 25 gtt/min
4.IV infusion rates

Answer: Δ = 12 %

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

500/8 = 62.5 mL/h

New rate

R = 350/5 = 70 mL/h

Percentage change

Δ = (70 − 62.5)/62.5·100% = 12%

Answer

Δ = 12%

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

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