Notes

A significant plasma volume deficit should be replaced with colloid solutions since crystalloids are rapidly lost from the plasma, particularly during periods of increased capillary leak, e.g. sepsis. As most plasma substitutes are carried in saline solutions, any additional 0.9% saline crystalloid infusion is only needed to replace excess sodium losses.

The sodium content of 0.9% saline is equivalent to that of extracellular fluid. A daily requirement of 70-80mmol sodium is normal although there may be excess loss in sweat and from the gastrointestinal tract.

Ringer's lactate or Hartmann's solution have no practical advantage over 0.9% saline for fluid maintenance. They may, however, be useful if large volumes of crystalloid are used to avoid hyperchloraemic acidosis. Hyperchloraemic acidosis may adversly affect coagulation and renal function.

5% glucose is used to supply intravenous water requirements. The 50g/l glucose content ensures an isotonic solution but only provides 200Cal/l. Normal requirement is approximately 1.5-2l/day. Water loss in excess of electrolytes is uncommon but occurs in excess sweating, fever, hyperthyroidism, diabetes insipidus and hypercalcaemia.

Potassium chloride must be given slowly since rapid injection may cause fatal arrhythmias. No more than 40mmol/h should be given although 20mmol/h is more usual. The frequency of infusion is dictated by plasma potassium measurements.

P.177

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