Fluid and electrolyte therapies including nutritional support are markedly developing in medicine
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1 J Korean Med Assoc 2010 December; 53(12): DOI: /jkma pissn: eissn: Continuing Education Column Fluid therapy: classification and characteristics of intravenous fluids Sun Joon Bai, MD Jong Wha Lee, MD Ki-Young Lee, MD* Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea * Corresponding author: Ki-Young Lee, kylee504@yuhs.ac Received October 18, 2010 Accepted November 3, 2010 Abstract Fluid and electrolyte therapies including nutritional support are markedly developing in medicine and many kinds of commercial fluids are being introduced to clinical practice. Understanding the characteristics and usefulness of intravenous fluids is necessary to manage patients properly. Disputes about the usefulness of crystalloid or colloid solutions for specific clinical conditions still continue. To make ideal fluid therapy possible, many kinds of fluids will be developed and applied to clinical practice in the near future by mimicking the composition and functions of human body fluids. The selection of crystalloid and colloid solutions for fluid therapy should be performed by considering patients clinical and pathophysiological conditions and the characteristics and usefulness of each intravenous fluid. Keywords: Fluid therapy; Intravenous fluid; Crystalloid solution; Colloid solution c Korean Medical Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. J Korean Med Assoc 2010 December; 53(12):
2 Bai SJ Lee JW Lee KY Table 1. Calculations of fluid requirements by rule a) Body weight Fluid rate Weight category Fluid (kg) (ml/kg) (kg) (ml/hr) > Total a) Assumes a patient weighing 25 kg, resulting in an estimated fluid requirement of 65 ml/hr J Korean Med Assoc 2010 December; 53(12):
3 Fluid therapy: classification and characteristics of intravenous fluids Table 2. Comparison of plasma and crystalloid infusion fluids meq/l Osmolality Fluid Na + Cl - K + Ca ++ Mg ++ Buffers ph (mosm/l) Plasma Bicarbonate (25) % NaCl Lactated Lactate (28) Ringer s Normosol Plasma-Lyte Acetate (27) lsolyte a) Gluconate (23) a) lsolyte also contains phosphate (1 meq/l). J Korean Med Assoc 2010 December; 53(12):
4 Bai SJ Lee JW Lee KY 1106 J Korean Med Assoc 2010 December; 53(12):
5 Fluid therapy: classification and characteristics of intravenous fluids J Korean Med Assoc 2010 December; 53(12):
6 Bai SJ Lee JW Lee KY Table 3. Comparative features of colloid Fluid Average Oncotic Plasma volume/ Duration of molecular weight pressure Infusate volume effect (hr) (kilodaltons) (mm Hg) 25% Albumin % Dextran % Hetastarch % Albumin Data from References 1, 12-14, and J Korean Med Assoc 2010 December; 53(12):
7 Fluid therapy: classification and characteristics of intravenous fluids Table 4. Electrolyte concentration of balanced HES-preparations Electrolyte Plasma Hextend Volulyte (mmol/l) HES a) 670/0.75 HES 130/0.4 Na K Ca Mg Phosphate Cl Lactate Acetate Na + /Cl - -ratio a) HES: hetastarch J Korean Med Assoc 2010 December; 53(12):
8 Bai SJ Lee JW Lee KY Table 5. Crystalloids vs. colloids Crystalloid Colloid Intravascular persistence Poor Good Hemodynamic stabilization Transient Prolonged Required infusion volume Large Moderate Risk of tissue edema Obvious Insignificant Enhancement of capillary Poor Good Risk of anaphylaxis - Low to moderate Colloid oncotic pressure Reduced Maintained Cost Inexpensive More expensive 1110 J Korean Med Assoc 2010 December; 53(12):
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