Fluid Resuscitation in Sepsis

Instructor: Tara Schickel

Tara has taught staff nursing courses and has a master's degree in public health.

This article will define sepsis and describe the reason septic patients need intravenous fluids in order to get better. We will talk about the amount and type of fluid necessary to protect the patient.

Defining Sepsis

Mike is a new nurse at Smithville Hospital. He is starting his first week in the ICU after being with a preceptor for the previous 12 weeks. Mike is excited about his new career and hopes to continue to learn a lot about caring for acutely ill patients. Today's assignment for Mike is a 74-year-old gentleman, Mr. Jones, who is being admitted to the ICU with a diagnosis of sepsis.

Mike understands that sepsis is an inflammatory response to severe infection that impacts the entire body. He also knows that it is important to recognize the severity of sepsis and ensure the proper treatment is being followed because it can quickly progress to severe sepsis and septic shock. Septic shock is one of the leading causes of death in non-coronary ICUs.

Fluids, Fluids, and More Fluids

Mike places a call to the physician to request an order for intravenous fluid boluses for Mr. Jones. He does this because he understands that septic patients, especially those with severe sepsis or septic shock, will have lower circulating blood volume than is needed for tissue perfusion. The low circulating blood volume is caused by vasodilation, a widening of the blood vessels often present in severe infections. Without a large amount of intravenous fluid replacement to restore circulating volume, the patient's blood pressure will become dangerously low.

Is There A Certain Amount of Fluid?

Before he places the call, Mike asks a fellow nurse for advice regarding how much fluid he should anticipate Mr. Jones needing. Sally, Mike's colleague and experienced nurse, informs Mike that the amount of fluid will likely be patient-specific. However, the recommended guidelines for severe sepsis suggest an initial fluid bolus of 30 ml of fluid for each kilogram of patient body weight. Mike will need to determine Mr. Jones' weight and multiply his weight in kilograms by 30 to reach an approximation of the necessary amount of replacement fluids.

Mike also learns that if a patient is in septic shock, large amounts of fluid over very brief periods of time will be necessary. The recommendations suggest 500-1000 ml over 30 minutes. This may have to be repeated multiple times, depending on how the patient responds to the fluid.

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