Understanding IV Fluids: Maintenance Therapy, Hypernatremia
Channel: QuickGuidesForMedicine
Date: 2020-07-15

In this video I discuss IV fluid options for Maintenance Therapy, Hypernatremia. Feel free to jump to your preferred section. 

⏰ Timestamps:

Maintenance Fluids - 0:18

Hypernatremia - 3:47

**Maintenance Fluid therapy**

This will be required in a patient that is unable to undergo nutrition via enteral or parenteral means mostly during perioperative period, or in patients with increasing insensible loss of fluids either when on a ventilator, severely ill, Febrile, burns etc.

The idea around maintenance fluid therapy is that patients require less than 1 L of electrolyte free water per day. So a good idea will be to give these patients 2L of **0.45%NS with D5W**. In this combination patient gets the less than 1L electrolyte free water they need, 3.4g of Na, and about 400cal contributed by D5 which triggers Insulin release and prevents catabolism mediated by glucagon. 20meq of potassium may be added per liter depending on the serum potassium levels or needs.

**D5W does not provide required caloric need**

Although D5W ma offer some caloric content, it is no way near what patients need for recovery during critical illness. So while maintenance therapy with D5 may be ok for few days, critically ill patients unable to receive enteral nutrition should be given parenteral nutrition via PPN or TPN.

**Hypernatremia:**

Hypernatremia can primarily be seen as free water loss or deficit so the goal here should be replacing free water with D5. however, when there is need some volume expansion in these patients 0.45%Ns may be added depending on the goal rate of Na reduction. You may also find 0.2% or 0.3% NS added with the D5 in cases where the Hypernatremia may be worsening while at the same time needing volume expansion. Keep in mind that Glucose is a transferring solute between the ECF and the ICF so it would not be beneficial as volume expansion, hence addition of NS based solution would be needed for volume expansion in this case. Although not commonly used, Lactated ringers with D5W sounds better in this scenario where there is Hypernatremia and Hypovolemia. This needs more research.

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