Shock-Dose Fluid Administration
Basic Information 
Indications
• Maintain adequate hydration for normal metabolic processes.
• Restore fluid losses due to dehydration or relative losses from fluid shifts due to endotoxemia.
• Replenish ongoing fluid losses due to diarrhea, nasogastric reflux, or excessive sweating.
• Preload the cardiovascular system to prevent cardiovascular collapse due to an acute loss of third-space fluid through a drain (peritonitis, pleuritis).
Contraindications
• Oral fluids: Contraindicated with concurrent nasogastric reflux, suspected small intestinal obstruction or severe dehydration (>8%).
• Large volume resuscitation: Contraindicated with cardiac disease, pulmonary or cerebral edema or anuria.
• Coagulation disorders: IV catheters may result in thrombophlebitis.
Preparation: Important Checkpoints
• Physical examination and hematocrit provide an estimate of the level of dehydration (<5% is undetectable).
Heart rate 40 to 60 bpm, capillary refill time (CRT) <2, packed cell volume (PCV) = 40%, total protein (TP) = 7.0 g/dL is 6% dehydration.
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