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Pt had complain of vomiting multiple times which iv fluid is given to pt

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Here is a complete, textbook-backed answer:

IV Fluid for a Patient with Repeated Vomiting

Why vomiting causes a specific electrolyte problem

Repeated vomiting leads to loss of gastric secretions, which are rich in HCl, Na+, K+, and water. This produces:
  • Hypochloremic metabolic alkalosis - HCl loss raises serum HCO3-
  • Hypokalemia - K+ is lost in vomitus and kidneys excrete K+ to retain H+ (paradoxical aciduria)
  • Volume depletion / dehydration
As confirmed by multiple textbooks: "Vomiting of gastric contents alone causes loss of HCl secreted by the stomach mucosa. The net result is loss of acid from the extracellular fluid and development of metabolic alkalosis." - Guyton and Hall Textbook of Medical Physiology

IV Fluid of Choice

Clinical SituationFluid of Choice
Vomiting with dehydration (standard)Normal Saline (0.9% NaCl) = Isotonic saline
Vomiting with severe hypokalemiaNormal Saline + KCl added (20-40 mEq/L)
Vomiting in children (ORS not tolerated)Normal Saline or Ringer's Lactate
Vomiting + DKANormal Saline (first choice)

Why Normal Saline (0.9% NaCl)?

  1. Chloride replacement - NS provides Cl- to correct the hypochloremia and directly helps correct the metabolic alkalosis
  2. Volume repletion - restores the extracellular fluid volume lost from vomiting
  3. Schwartz's Principles of Surgery states: "Treatment includes replacement of the volume deficit with isotonic saline and then potassium replacement once adequate urine output is achieved."
  4. Guyton and Hall confirms: "Repletion of volume by infusion of isotonic saline solution is often beneficial in correcting the alkalosis."
  5. Current Surgical Therapy 14e states: "For acute chloride loss-induced metabolic alkalosis, patients can receive chloride in the form of normal saline, in addition to potassium replacement."

Practical Protocol

  1. Start with isotonic Normal Saline (0.9% NaCl) - to correct volume depletion and chloride loss
  2. Add KCl (20-40 mEq/L) to each bag once urine output is confirmed (to correct hypokalemia)
  3. Rate: typically 125-150 mL/hr depending on degree of dehydration; adjust for clinical response (BP, HR, urine output)
  4. Monitor: serum Na+, K+, Cl-, pH, and urine output
  5. Anti-emetics: IV ondansetron or metoclopramide to stop ongoing losses

What NOT to give

  • Ringer's Lactate is generally avoided as the primary choice because lactate is metabolized to bicarbonate, which would worsen the already existing metabolic alkalosis
  • Dextrose alone (D5W) - does not replace electrolytes
  • Sodium bicarbonate - absolutely contraindicated (worsens alkalosis)
In summary: The IV fluid of choice for a patient vomiting multiple times is Normal Saline (0.9% NaCl), correcting both volume depletion and hypochloremic metabolic alkalosis. Potassium (KCl) is added once urine output is established to address concurrent hypokalemia.
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