Intravenous fluids cannot be given at any speed one feels like, especially if some medicines have been added to them. Even if there are no such additions, the infusion rate has to be controlled in case the patient has a disease of the heart or kidneys, or overloading of fluid may harm or even kill the patient. Our resident doctors must know this, since it is part of their education as undergraduates. Unfortunately what they learn for passing an examination and what they remember at the time of treating their patients are sometimes poles apart. That day I found such an example on my morning round of the labor ward. There was a patient who was in need of being delivered for obstetric reasons. Unfortunately she was not getting any labor pains. My residents had started an intravenous infusion of saline with oxytocin - a medicine to cause labor pains. She still was not getting any pains. I glanced at the chamber of the infusion set and found that the infusion was going at top speed. Actually oxytocin can make very powerful contractions of the uterus, and make it rupture if it is given fast.
"Why are we giving her oxytocin infusion at such a top speed?" I asked. There was no answer. If I had asked them to slow it, they would have done so and moved on, only to repeat the same mistake some time later.
I had to make an impression on their minds so that they would remember it.
"Are you giving the fluid so fast because its expiry date is today? I asked. There was momentary silence, and when the meaning of what I had asked dawned on them, they laughed. It is a common practice to use up medicines whose expiry date is approaching because they cannot be used safely after that date. However saline need not be used fast even if it is going to expire on that day, since a bottle gets over in a few hours even if it given very slowly. There cannot be any need to rush through it on these grounds. A little sarcasm achieved what a lot of shouting or scolding would not have achieved. They did not give intravenous fluids at such rapid rates without reason again.
