Hospital patients require intravenous fluid (IV) and electrolytes for one or more of the following reasons (4Rs):
Fluid-based resuscitation
Intravenous fluids may require urgent administration to restore blood flow to important organs after loss of intravascular volume due to bleeding, plasma loss, or excessive loss of external fluids and electrolytes, mostly from the gastrointestinal tract (GI) or severe internal losses (e.g., fluid redistribution in sepsis).
Routine Maintenance
Intravenous fluids are sometimes required for patients who simply cannot meet their normal oral or enteral fluid or electrolyte needs, but are otherwise well able to manage fluid and electrolyte balance and handling, i.e. essentially evolemic fluids without significant deficits, continuous abnormal losses or problems with redistribution. However, even when prescribing intravenous fluids in more complex cases, there is still a need to meet routine patient maintenance requirements and adapt the prescription for maintenance to address more complex fluid or electrolyte problems. Therefore, estimates of routine maintenance requirements are required for all patients performing intravenous liquid therapy.
Replacement
In some patients, IV fluid is not urgently needed for resuscitation to treat losses from endovascular or other fluid compartments, but further to correct existing water deficits and/or electrolytes or current external losses. These losses usually originate from the gastrointestinal tract or urinary tract, although in the case of fever high insensitive losses occur and patients may lose large amounts of effective plasma. Sometimes these deficits develop slowly with accompanying compensatory adaptation of the tissue electrolyte and fluid distribution, which must be taken into account in subsequent exchange patterns (e.g. careful, slow exchange to reduce the risk of pontoon demyelinosis).
Redistribution
In addition to the loss of external fluid and electrolytes, some hospital patients have reported changes in internal fluid distribution or fluid handling. This type of problem occurs particularly in people who are septic, otherwise seriously ill, after major surgery or with severe comorbidities of the heart, liver or kidney. Many of these patients experience swelling due to excess sodium and water and some sequestration fluid in the gastrointestinal tract or in the thoracic/peritoneal cavities.
While it is inherently difficult to determine the optimal amount, composition, and timing of intravenous fluid administration to meet these often complex needs, it is often left to younger doctors and nurses who do not have the training and expertise to assess, prescribe, and monitor intravenous fluids in the general admission and hospital setting.56,57,86,87,93 Evidence suggests that fluid mismanagement is widespread, particularly in general wards, with potential for adverse effects, including excessive morbidity and mortality, longer hospital stays and higher costs.6,39,73,73,73.
There is therefore a clear need for guidelines for prescribing intravenous fluids in the general ward, but since most randomized controlled trials of intravenous fluid therapy have investigated narrow clinical issues in the ICU or intraoperative setting, many recommendations for more generic use must be based on the first principles. All healthcare professionals involved in the prescription and administration of intravenous fluids must understand these principles if they are to prescribe and administer intravenous fluid therapy safely and effectively.
Translated with www.DeepL.com/Translator