Lastly, always reassess for the ability to decrease IV medication exposure when appropriate - every day is a chance to WEAN sedation and DISCONTINUE inappropriate antibiotics. 👏👏👏

Thanks for reading! 🙏

If you are REALLY trying to fluid restrict, consider CONCENTRATING your drips to further minimize volume intake (i.e., switch from Single-strength norepinephrine to Double- or Quad-strength). 💪💪💪💪

To minimize overall fluid intake, make sure you consider ALL sources of IV fluids.

This patient is receiving ~90 ml/hr of IV fluids so maybe they don’t also need a “maintenance” infusion of Sodium Chloride 0.9% or Lactated Ringer's running continuously throughout the day.

This patient is receiving:
Piperacillin-tazobactam 3.375 g/50 mL q6h
Vancomycin 1250 mg/250 mL q12h

This adds an additional 200 mL plus 500 mL per day for a GRAND total of 2,197 mL in 24 hours from three IV drips and two intermittent IV piggybacks! 💧💧💧

But wait, a patient with septic shock must also be getting ANTIBIOTICS to treat their infection! 🦠

While most antibiotics are not continuous infusions, you should definitely account for the volume with each IV piggyback.

How much volume is added from the norepinephrine drip? 39.375 mL/hr or 945 mL in 24 hours!

This brings our total to 1,497 mL in 24 hours! 💧💧

Say this patient is also in SEPTIC SHOCK. ⚡️ They will initially be receiving VASOPRESSORS to improve organ perfusion.

So, our patient is also on:
Norepinephrine 8 mg/250 mL at 0.3 mcg/kg/min

How much volume will the patient receive from these two drips? Quick pharmacy math calculates out at 12.5 mL/hr and 10.5 mL/hr which adds up to 552 mL in 24 hours! 💧

And these drips are not even maxed out!

Say you have a patient who is intubated and on mechanical ventilation. They will most likely be receiving IV drips for SEDATION and/or ANALGESIA.

Here we have a pt (weighing 70 kg) on the following:
Fentanyl 2000 mcg/250 mL at 100 mcg/hr
Propofol 1000 mg/100 mL at 25 mcg/kg/min

Rabies
Rotavirus
RSV
Rubella
S. aureus
S. flexneri, shigella
S. typhi, salmonella
SARS-CoV-2
Smallpox
S. pneumoniae, various serotypes
Varicella
Vibrio chloerae, cholera
Yellow fever

Herpes simplex
Herpes zoster
HIV, various types
HPV
Influenza, various types
Japanese encephalitis
Leishmaniasis
Measles
M. tuberculosis
Mumps
N. meningitidis, various serotypes
Norovirus
Parvovirus
Plasmodium falciparum, malaria
Polio
P. aeruginosa

B. anthracis, anthrax
B. burgdorferi, Lyme disease
B. pertussis, pertussis
Chikungunya
C. diphtheriae, diptheria
C. tetani, tetanus
C. trachomatis, chlamydia
CMV
Dengue
Ebola
E. coli
Enterovirus
EBV
H. influenzae
H. pylori
Hep A
Hep B
Hep C
Hep E

See you’re part of the problem!

✅✅✅