Continued fluid needs

Continued fluid needs refer to those that remain after the initial phase of patient stabilization (e.g., after the first 2–4 hours) and are typically administered slowly over the following 24–48 hours.

• Address any urgent continued fluid needs: Begin management concurrently with initial fluids for dehydration and hypovolemia.

  • Correct acute severe metabolic disturbances without delay, e.g., hypoglycemia, severe symptomatic hyponatremia.

  • Factor in significant ongoing fluid losses in patients with clinical deterioration.

• After stabilization with fluid resuscitation, calculate or estimate:

  • Remaining fluid deficit (to correct intracellular dehydration), including the free water deficit if there is hypernatremia [24]

  • Remaining ongoing fluid losses

  • Daily maintenance fluid requirements

  • Fluids required for ongoing treatment of associated metabolic disturbances, e.g., electrolyte repletion

• Determine the best route to replenish fluids.

  • Enteral fluids, including ORS, are preferred if tolerated.

  • IV fluids are indicated in patients with any of the following:

    • Inability to tolerate enteral fluids

    • Significant ongoing fluid loss that exceeds enteral fluid intake

    • Electrolyte abnormalities requiring IV correction

• Hypovolemic shock → prerenal renal failure

• Increased risk of infection, particularly of the urinary tract

• Thrombosis

• Osmotic demyelination syndrome

• Patients with diabetes mellitus: Dehydration can trigger diabetic ketoacidosis.