Enlist iv fluids
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I now have comprehensive textbook content. Here is the complete, organized enumeration of IV fluids:
Intravenous (IV) Fluids - Complete Classification
IV fluids are broadly divided into Crystalloids and Colloids. Crystalloid solutions are aqueous solutions of ions (salts) with or without glucose; colloid solutions additionally contain high-molecular-weight substances (proteins or large glucose polymers) that maintain plasma oncotic pressure. - Morgan & Mikhail's Clinical Anesthesiology, 7e
A. CRYSTALLOID SOLUTIONS
Crystalloids are the first-line resuscitation fluid in hemorrhagic/septic shock, burns, head injury, and most surgical/perioperative settings. - Fischer's Mastery of Surgery, 8e
1. Isotonic Crystalloids (Most Commonly Used)
| Fluid | Na⁺ (mEq/L) | Cl⁻ (mEq/L) | Osmolarity (mOsm/L) | Notes |
|---|---|---|---|---|
| 0.9% Normal Saline (NS) | 154 | 154 | 308 | Can cause hyperchloremic metabolic acidosis in large volumes; preferred for hypochloremic alkalosis and diluting PRBCs |
| Lactated Ringer's (LR) | 130 | 109 | 273 | Contains K⁺, Ca²⁺, lactate; balanced, avoids hyperchloremia |
| Hartmann's Solution | 131 | 111 | 278 | Similar to LR; widely used in UK/surgical settings |
| PlasmaLyte A / PlasmaLyte 148 | 140 | 98 | 295 | Balanced; contains acetate and gluconate; most physiologic |
| Ringer's Acetate | 130 | 112 | 276 | Balanced; acetate instead of lactate |
| Sterofundin / Ringerfundin | 145 | 127 | 309 | Balanced salt solution |
2. Hypotonic Crystalloids
| Fluid | Use |
|---|---|
| 0.45% NaCl (Half Normal Saline) | Replacement of free water deficits; must be given slowly to avoid hemolysis |
| 5% Dextrose in Water (D5W) | Pure water deficit replacement; becomes hypotonic in vivo once glucose is metabolized; maintenance for sodium-restricted patients |
| 0.45% NaCl + 5% Dextrose | Combined water and mild sodium replacement |
3. Hypertonic Crystalloids
| Fluid | Use |
|---|---|
| 3% Sodium Chloride | Severe symptomatic hyponatremia; raised ICP (cerebral edema) |
| 7.5% Sodium Chloride | Small-volume resuscitation in trauma/hemorrhagic shock (hypertonic saline resuscitation) |
| 5% Dextrose in 0.9% NaCl (D5NS) | Hypertonic; combined energy and sodium |
4. Glucose-Containing Crystalloids
| Fluid | Use |
|---|---|
| 5% Dextrose (D5W) | Free water replacement; prevents hypoglycemia in fasting children |
| 10% Dextrose | Hypoglycemia; neonatal/pediatric maintenance |
| Dextrose-Saline (D5 + 0.45% NaCl) | Maintenance fluid in children and post-op patients |
B. COLLOID SOLUTIONS
Colloids have an intravascular half-life of 3-6 hours (vs. 20-30 min for crystalloids), so 3-4x less volume is needed compared to crystalloids for the same intravascular expansion. - Morgan & Mikhail's Clinical Anesthesiology, 7e
1. Blood-Derived (Natural) Colloids
| Colloid | Details |
|---|---|
| Human Albumin 4-5% | Iso-oncotic; volume expansion; used in SBP, hepatic cirrhosis, nephrotic syndrome |
| Human Albumin 20-25% | Hyperoncotic; "concentrated albumin"; pulls fluid into vascular space |
| Plasma Protein Fraction (Plasmanate) 5% | Contains α- and β-globulins + albumin; can cause hypotensive allergic reactions at rapid infusion |
| Fresh Frozen Plasma (FFP) | Contains all clotting factors; coagulopathy, TTP, DIC |
2. Synthetic Colloids
Dextrans - complex polysaccharides; also reduce blood viscosity and platelet adhesion:
| Colloid | MW | Details |
|---|---|---|
| Dextran 40 (Rheomacrodex) | 40,000 Da | Hyperoncotic 10% solution; improves microcirculation; peripheral vascular disease, hyperviscosity syndromes; excreted rapidly |
| Dextran 70 (Macrodex) | 70,000 Da | 6% solution; larger molecule, effect maintained up to 48 hrs; volume expander |
Gelatins - histamine-mediated allergic reactions (not available in the USA):
| Colloid | Details |
|---|---|
| Gelofusine | Succinylated gelatin; plasma expander |
| Haemaccel (polygeline) | Urea-crosslinked gelatin |
Starches (Hydroxyethyl Starch / HES):
| Colloid | Details |
|---|---|
| Hetastarch / HES (Voluven, Volulyte) | Highly effective plasma expander; designated by concentration/molecular weight/molar substitution; duration ~36 hrs; potentially nephrotoxic; AVOID in critically ill, AKI risk, sepsis |
| Pentastarch | Lower MW than HES; shorter action (~2.5 hrs); fewer side effects |
C. BLOOD PRODUCTS (Separately Classified)
| Product | Primary Use |
|---|---|
| Whole Blood | Massive hemorrhage (MHP protocol) |
| Packed RBCs (PRBCs) | Anemia, hemorrhage |
| Fresh Frozen Plasma (FFP) | Coagulopathy, TTP, DIC |
| Platelet Concentrate | Thrombocytopenia, platelet dysfunction |
| Cryoprecipitate | Fibrinogen deficiency, hemophilia A, vWD |
Key Clinical Principles (Summary)
| Point | Detail |
|---|---|
| Volume needed | Crystalloids need 3-4x more volume than colloids for same intravascular effect |
| First choice in shock | Isotonic crystalloids (NS or balanced salt solutions) |
| Preferred balanced solution | LR or PlasmaLyte preferred over NS (less hyperchloremic acidosis) |
| NS preferred when | Correcting hypochloremic metabolic alkalosis; diluting PRBCs; TBI |
| HES - avoid in | Critical illness, sepsis, AKI risk - associated with kidney injury and increased mortality |
| Dextrans - avoid in | Kidney disease; limit to 20 mL/kg/day to avoid bleeding complications |
| Large volume crystalloids (>4-5 L) | Risk of tissue edema, impaired wound healing, bowel dysfunction, SSI |
- Morgan & Mikhail's Clinical Anesthesiology, 7e
- Fischer's Mastery of Surgery, 8e
- Mulholland & Greenfield's Surgery, 7e
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