critical care medicine
Intravenous Fluid Resuscitation
Route and Rate of Fluid Administration
Standard, large (eg, 14- to 16-gauge) peripheral IV catheters are adequate for most fluid resuscitation. With an infusion pump, they typically allow infusion of 1 L of crystalloid in 10 to 15 minutes and 1 unit of red blood cells in 20 minutes. For patients at risk of exsanguination, a large (eg, 8.5 French) central venous catheter provides more rapid infusion rates; a pressure infusion device can infuse 1 unit of red blood cells in<5 minutes. Patients in shock typically require and tolerate infusion at the maximum rate. Adults are given 1 L of crystalloid (20 mL/kg in children) or, in hemorrhagic shock, 5 to 10 mL/kg of colloid or red blood cells, and the patient is reassessed. An exception is a patient with cardiogenic shock who typically does not require large volume infusion. Patients with intravascular volume depletion without shock can receive infusion at a controlled rate, typically 500 mL/hour. Children should have their Practical Rehydration Example and replacement given over 24 hours (half in the first 8 hours). 