Basic Concepts of Fluid and Electrolyte Therapy

Fluids and insulin
In the absence of shock or oliguria, give 1-2 l of crystalloid (see
below) in the first 2 hours, the 1 l over the next 4 hours and 4 l
over the next 24 hours. In severe cases, administration should be
faster initially, aiming to correct half the fluid deficit within the
first 6 hours and the remainder over the ensuing 24 hours. With
HONK the fluid deficits are larger (Table 23)
After the first litre of fluid add KCl 20-40 mmol to each sub -
sequent litre of fluid infused, depending on the changes in serum
K + with treatment.
To avoid precipitating cerebral oedema, the effective serum osmolality
shoud not be reduced at a rate greater than 3 mOsm/kg/h.
This is particularly important in cases involving children and the
elderly and in the treatment of HONK.
When the blood glucose has fallen to 14 mmol/l, change to a
hypotonic glucose-containing preparation adjusted according to
the insulin-induced changes in blood glucose and the serum sodium
and osmolality.
Treat hyperkalaemia and acidosis with fluid infusion, insulin, and,
in severe cases (pH