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
IntakeOutput8-hour shiftjelly120 mLsoup200 mLice chips100 mLIV infusion60 mL/h × 8 hIV antibiotic2 × 50 mLurine275 mLurine350 mLwound drain30 mLvomit150 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.

jelly: 120 mLsoup: 200 mLice chips: 100 mLIV infusion: 60 mL/h × 8 hIV antibiotic: 2 × 50 mL
I = mL
2.IV fluids & fluid balanceHard
500 mL300 mL infused50 mL/h15:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 50 mL/h. At 15:00, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL300 mL infused50 mL/h
t = h
3.IV infusion ratesMedium
15 gtt/mL40 mL/h? gtt/min

An infusion is ordered at 40 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.

40 mL/h15 gtt/mL
R = gtt/min
4.IV infusion ratesHard
4 g500 mL? mL/h1 mg/min

A bag contains 4 g of a drug in 500 mL. The order is 1 mg per minute. At what rate R do you set the pump, in mL/h?

4 g/500 mL1 mg/min
R = mL/h

3Solutions

1.IV fluids & fluid balance

Answer: I = 950 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.

Add the intake

oral: 120 + 200 = 320 mL
ice chips: 100/2 = 50 mL
IV infusion: 60·8 = 480 mL
IV antibiotic: 2·50 = 100 mL
I = 950 mL

Answer

I = 950 mL
2.IV fluids & fluid balance

Answer: t = 4 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 = 200/50 = 4 h

Answer

t = 4 h

That is about 4 h 00 min, so the bag runs out at about 19:00.

3.IV infusion rates

Answer: R = 10 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

40/60 = 0.6667 mL/min

Drip rate

R = 0.6667·15 = 10 gtt/min

Answer

R = 10 gtt/min
4.IV infusion rates

Answer: R = 7.5 mL/h

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

4000 mg/500 mL = 8 mg/mL

Dose per hour

1·60 = 60 mg/h

Pump rate

R = 60/8 = 7.5 mL/h

Answer

R = 7.5 mL/h

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