• A sterile isotonic crystalloid solution

Pharmacology Review

  • Fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest.
  • Severe Pulmonary Oedema
 Precautions / Notes
  • Adult patients with penetrating trauma, ectopic pregnancy or aortic aneurysm with hypotension and signs of impaired organ perfusion may benefit from permissive hypotension (systolic blood pressure of 70mmHg)
  • Fluid Therapy for shock, DKA & Hyperosmolar Hyperglycaemic State: Initial fluid therapy is directed toward expansion of the intravascular, interstitial, and intercellular volume, all of which are reduced in hyperglycaemic crises and restoration of renal perfusion.
 Weight-based Calculations
IV Saline for Cardiac Arrest
Calculated dose: 
IV Saline for Post ROSC
Calculated dose: 
Subsequent dose: 
IV Saline for shock, DKA, HHS
Calculated dose:  over 5-10mins
IV Saline for burns
Total Burn Surface Area (TBSA, %)
Fluid administration (mL):  
50% (mL) of total amount over the first 8 hours
mL ( drops) per minute
mL per hour
50% (mL) of total amount over next 16 hours
IV Saline for haemorrhage
Calculated dose:  (4x repeat to a maximum of 1L)

  • 20 drops per minute (20 drops = 1ml)
Fluid Therapy for shock, DKA & Hyperosmolar Hyperglycaemic State
  • 250ml boluses to a maximum total of 2000ml
  • Small adult/elderly 250ml boluses up to maximum total of 1000ml


  • 10ml/kg over 5-10 minutes. Repeat once only


  • Infuse 250ml boluses maximum total 2000ml with reassessment between each infusion


  • Hypotensive paediatric patients should receive IV fluids; 10ml/kg (max. 250ml bolus) reassessment between each bolus (4x infusions maximum) to a total infusion not exceeding 1000ml
Cardiac Arrest

Adult / Paediatric:

  • 20ml/kg bolus as a reversible cause of hypovolaemia


  • 10ml/kg as a reversible cause of hypovolaemia
  • Manage hypotension in Post-ROSC patients if BP is slow to rise:
    • The patient is considered hypotensive if Systolic BP is:
      • Adult: < 100mmHg
      • Paediatric: < 80mmHg


  • 250ml boluses to a maximum total of 500ml with reassessment between each infusion


  • 10ml/kg, repeat once only with reassessment between each infusion (bolus max. 250ml)

Apply modified Parkland Formula to patients that meet the following criteria:


  • > 15% TBSA


  • ≥ 18 months and > 10% TBSA OR
  • < 18 months and > 8% TBSA

Modified Parkland Formula:

  • 2ml x %TBSA x weight of patient
  • 50% of total amount over first 8 hours
  • 50% of total amount over next 16 hours

Parkland Calculator

An online calculator to assist in determining fluid administration for burns.

Parkland Calculator

Critical Care & Paramedic – Special Operations
  • Consider MEQU Fluid & Blood Warmer for intravenous fluid replacement in:
    • Paediatric patients
    • Burns patients
    • Patients with hypothermia 
Crush Injury
  • 20mL/kg bolus doses titrated to effect
  • Subsequent dosages of 20mL/kg/hr (Maximum total dose 60mL/kg i.e. 2 hours entrapment)
  • Consult ASMA for further advice
 Special Considerations
  • Hypervolemia
  • Normal saline (NaCl 0.9%) in 1000 ml soft plastic bag
  • Normal saline (NaCl 0.9%) in 250 ml soft plastic bag
  • 10 ml plastic vial
  • Normal saline (NaCl 0.9%) sterile pre-filled 5 ml flush syringe
BD 5ml POSI flush
Current mode:
Extended Care:
Colour assist:

Kitabchi, A.E., Umpierrez, G.E., Miles, J.M. and Fisher, J.N. (2009). Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, [online] 32(7), pp.1335–1343. doi: https://doi.org/10.2337/dc09-9032 .

Document Control

Clinical Services

Responsible Manager
Head of Clinical Services


Issue Date

Expiry Date

Clinical Resources Website

St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.

Other users – Terms of Use

The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.

St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.

St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website. 

No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au

Where links are provided to resources on external websites, St John WA:

  • Gives no assurances about the quality, accuracy or relevance of material on any linked site;
  • Accepts no legal responsibility regarding the accuracy and reliability of external material; and
  • Does not endorse any material, associated organisation, product or service on other sites.

Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.

To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).


Please read this cookie policy carefully before using Clinical Resources from St John WA.

The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.

Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.

If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.

St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

Terms of Use | Privacy Policy | Copyright Statement & Disclaimer