Choice of Fluid For Doctors

সূচীপত্র

Choice of IV Fluids in Common Clinical Conditions

1. Diarrhoea

   Cholera Saline (ORS type IV fluid)

   To replace sodium, potassium, bicarbonate loss. Especially vital in secretory diarrhoea (cholera).
   Alternative: Ringer’s lactate.

2. Vomiting

   Normal Saline (0.9% NaCl)

   Vomiting causes loss of H⁺ and Cl⁻ leading to metabolic alkalosis — NS corrects chloride deficit and volume loss.

3. Hypovolemic Shock

   Ringer’s Lactate (Hartmann’s Solution)

   Balanced crystalloids replace plasma-like composition; restores volume rapidly.
   If severe: Start with rapid bolus 20 ml/kg.

4. Head Injury

   Normal Saline

   Avoid hypotonic or dextrose fluids; they worsen cerebral edema. NS maintains osmolarity without increasing ICP.

5. NPO (Nil Per Oral) Maintenance

   1 L 5% Dextrose + NS / Half NS (alternate)

   Prevent hypoglycemia and dehydration in fasting patients. A balanced combo is 1L 5% Dextrose in NS over 8 hr (adult).

6. Diarrhoea + Vomiting

   Cholera Saline

   Covers both volume depletion and electrolyte loss (Na⁺, K⁺, HCO₃⁻).

7. DKA (Diabetic Ketoacidosis)

   Normal Saline initially

   Rapid isotonic rehydration first 1–2 hr. Later switch to ½ NS + 5% Dextrose once glucose <14 mmol/L.

8. Stroke

   Normal Saline (Never use Dextrose/DNS)

   Dextrose worsens cerebral edema and hyperglycemia, both harmful in stroke. Use NS for hydration and IV meds.

9. SAH / ICH with ↑ICP

   Mannitol (20%) or 3% NaCl

   Osmotic agents draw fluid from brain tissue, reducing intracranial pressure.

Quick Mnemonics Tip:
“D–N–H–H–N–D–D–S–S” → Diarrhea–NS (vomit)–Hypovolemia–Head injury–NPO–DKA–Decompensated stroke–SAH–Saline therapy.