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Introduction
  • A sterile isotonic crystalloid solution

Pharmacology Review

Indications
  • Fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest.
Contraindications
  • 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)
Management
KVO
  • 20 drops per minute (20 drops = 1ml)
Fluid Therapy for shock, DKA & Hyperosmolar Hyperglycaemic State[1])

Adult:

  • 250ml boluses to a maximum total of 2000ml
  • Small adult/elderly 250ml boluses up to maximum total of 1000ml

Paediatric:

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

Adult / Paediatric:

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

Newborn:

  • 10ml/kg as a reversible cause of hypovolaemia
Post ROSC

Adult:

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

Paediatric:

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

Adult:

  • 1 litre stat, followed by 1 litre over 1 hour for TBSA >25% (Max. 2 litres)
  • 1 litre over 1 hour for TBSA 15%-25% and 30 minutes transport time (Max. 1 litre)

Paediatric:

  • 10ml/kg over 1 hour for TBSA > 10% and 30 minutes transport time
Haemorrhage

Adult:

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

Paediatric:

  • 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
Critical Care & Special Operations Paramedics Only
  • 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
References
References
Presentation
  • Normal saline (NaCl 0.9%) in 1000ml soft plastic bag
  • Normal saline (NaCl 0.9%) in 250ml soft plastic bag
  • 10 ml plastic vial
10ml-saline
Saline-250
1000ml-saline

Further reading:

[1] Initial fluid therapy is directed toward expansion of the intravascular, interstitial, and intracellular volume, all of which
are reduced in hyperglycaemic crises and restoration of renal perfusion.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699725/pdf/zdc1335.pdf

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