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 shiftwater300 mLsoup180 mLjelly120 mLice chips200 mLIV infusion60 mL/h × 12 hIV antibiotic2 × 50 mLurine200 mLurine350 mLurine275 mLurine300 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 total intake I in mL. Count ice chips as half their volume.

water: 300 mLsoup: 180 mLjelly: 120 mLice chips: 200 mLIV infusion: 60 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
2.IV fluids & fluid balanceHard
500 mL→ 125 mL/hstart 06:30ttotal​ = ? h80 mL/h × 3 h

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 06:30 at 80 mL/h. After 3 hours the rate is changed to 125 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

500 mL80 mL/h · 3 h125 mL/h
t = h
3.IV infusion ratesMedium
170 mLleft? mL/h3 h left

500 mL was ordered over 10 hours. After 7 hours you find that 170 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?

500 mL / 10 hafter 7 h: 170 mL
R = mL/h
4.IV infusion ratesHard
900 mL20 gtt/mL40 gtt/mint = ? h

A drip runs at 40 gtt/min through a set of 20 gtt/mL. There are 900 mL left in the bag. How many hours t until it is empty?

40 gtt/min20 gtt/mL900 mL
t = h

3Solutions

1.IV fluids & fluid balance

Answer: I = 1520 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: 300 + 180 + 120 = 600 mL
ice chips: 200/2 = 100 mL
IV infusion: 60·12 = 720 mL
IV antibiotic: 2·50 = 100 mL
I = 1520 mL

Answer

I = 1520 mL
2.IV fluids & fluid balance

Answer: t = 5.1 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.

First part

80·3 = 240 mL
500 − 240 = 260 mL left

Second part

260/125 = 2.08 h

Total time

t = 3 + 2.08 = 5.08 ≈ 5.1 h

Answer

t = 5.1 h

That is about 5 h 05 min, so the bag runs out at about 11:35.

3.IV infusion rates

Answer: R = 56.67 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

500/10 = 50 mL/h

New rate

R = 170/3 = 56.67 mL/h

Answer

R = 56.67 mL/h

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

4.IV infusion rates

Answer: t = 7.5 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.

Rate in mL/h

40·60/20 = 120 mL/h

Time left

t = 900/120 = 7.5 h

Answer

t = 7.5 h

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