Describe the initial fluid therapy for dehydration/hypovolemia.
Administer isotonic fluid and choose route and rate based on estimated fluid loss.
Severe fluid loss (hypovolemic shock): Begin immediate hemodynamic support with aggressive IV fluid resuscitation, e.g., 20 mL/kg bolus of isotonic crystalloid.
Moderate fluid loss (hypovolemia without shock)
Administer enteral OR parenteral fluids to correct extracellular volume deficit.
If starting with IV fluids, transition to enteral fluids as soon as possible.
Mild fluid loss: Prioritize enteral replacement of fluids (i.e., oral rehydration therapy).
Describe the supportive care for all patients.
Management of these is often begun concurrently with initial fluid administration.
Treat associated metabolic disturbances: e.g., glucose and electrolyte abnormalities.
Identify and treat underlying causes (see “Etiology”).
Address continued fluid needs.
Replace free water deficit to restore intracellular volume losses and correct hypernatremia.
Meet maintenance fluid requirements.
Replace ongoing fluid losses.
What is in general the first priority?
Stabilization through correction of intravascular volume deficit with fluid resuscitation is the first priority. Manage urgent metabolic abnormalities (e.g., severe symptomatic hyponatremia, acute hypoglycemia) concurrently with fluid resuscitation. Address subacute electrolyte abnormalities after stabilization.
Last changed2 years ago