Intravenous Fluid Management in Critically Ill Adults: A Review

Barlow, Ashley PharmD
Barlow, Brooke PharmD
Tang, Nancy PharmD
Shah, Bhavik M. PharmD, BCPS, AAHIVP
King, Amber E. PharmD, BCPS

Authors
Ashley Barlow is an oncology pharmacy resident, Department of Pharmacy Services, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Brooke Barlow is a critical care pharmacy resident at the University of Kentucky HealthCare, Lexington, Kentucky.
Nancy Tang is a clinical pharmacist at MedStar Washington Hospital Center, Washington, DC.
Bhavik M. Shah and Amber E. King are associate professors at Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania.

Corresponding author: Amber E. King, PharmD, BCPS, Jefferson College of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107 (email:[email protected]).

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Critical Care Nurse 40(6):p e17-e27, December 2020. | DOI: 10.4037/ccn2020337

Topic

This article reviews the management of intravenous fluids and the evaluation of volume status in critically ill adults.

Clinical Relevance

Intravenous fluid administration is one of the most common interventions in the intensive care unit. Critically ill patients have dynamic fluid requirements, making the management of fluid therapy challenging. New literature suggests that balanced salt solutions may be preferred in some patient populations.

Purpose of Paper

The bedside critical care nurse must understand the properties of various intravenous fluids and their corresponding impact on human physiology. The nurse’s clinical and laboratory assessments of each patient help define the goals of fluid therapy, which will in turn be used to determine the optimal patient-specific selection and dose of fluid for administration. Nurses serve a vital role in monitoring the safety and efficacy of intravenous fluid therapy. Although this intervention can be lifesaving, inappropriate use of fluids has the potential to yield detrimental effects.

Content Covered

This article discusses fluid physiology and the goals of intravenous fluid therapy, compares the types of intravenous fluids (isotonic crystalloids, including 0.9% sodium chloride and balanced salt solutions; hypotonic and hypertonic crystalloids; and colloids) and their adverse effects and impact on hemodynamics, and describes the critical care nurse’s essential role in selecting and monitoring intravenous fluid therapy. (Critical Care Nurse. 2020;40[6]:e17-e27)