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Intravenous fluid therapy in adults in hospital
NICE Clinical Guidelines, No. 174
This guideline is the basis of QS66.
Introduction
This guideline contains recommendations about general principles for managing intravenous (IV) fluids, and applies to a range of conditions and different settings. It does not include recommendations relating to specific conditions.
Many adult hospital inpatients need intravenous (IV) fluid therapy to prevent or correct problems with their fluid and/or electrolyte status. Deciding on the optimal amount and composition of IV fluids to be administered and the best rate at which to give them can be a difficult and complex task, and decisions must be based on careful assessment of the patient’s individual needs.
Errors in prescribing IV fluids and electrolytes are particularly likely in emergency departments, acute admission units, and general medical and surgical wards rather than in operating theatres and critical care units. Surveys have shown that many staff who prescribe IV fluids know neither the likely fluid and electrolyte needs of individual patients, nor the specific composition of the many choices of IV fluids available to them. Standards of recording and monitoring IV fluid and electrolyte therapy may also be poor in these settings. IV fluid management in hospital is often delegated to the most junior medical staff who frequently lack the relevant experience and may have received little or no specific training on the subject.
The National Confidential Enquiry into Perioperative Deaths report in 1999 highlighted that a significant number of hospitalised patients were dying as a result of infusion of too much or too little fluid. The report recommended that fluid prescribing should be given the same status as drug prescribing. Although mismanagement of fluid therapy is rarely reported as being responsible for patient harm, it is likely that as many as 1 in 5 patients on IV fluids and electrolytes suffer complications or morbidity due to their inappropriate administration.
There is also considerable debate about the best IV fluids to use (particularly for more seriously ill or injured patients), resulting in wide variation in clinical practice. Many reasons underlie the ongoing debate, but most revolve around difficulties in interpretation of both trial evidence and clinical experience, including the following factors:
- Many accepted practices of IV fluid prescribing were developed for historical reasons rather than through clinical trials.
- Trials cannot easily be included in meta-analyses because they examine varied outcome measures in heterogeneous groups, comparing not only different types of fluid with different electrolyte content, but also different volumes and rates of administration and, in some cases, the additional use of inotropes or vasopressors.
- Most trials have been undertaken in operating theatres and critical care units rather than admission units or general and elderly care settings.
- Trials claiming to examine best early therapy for fluid resuscitation have actually evaluated therapy choices made after initial fluid resuscitation, with patients already in critical care or operating theatres.
- Many trials inferring best therapy for fluid resuscitation after acute fluid loss have actually examined situations of hypovolaemia induced by anaesthesia.
There is a clear need for guidance on IV fluid therapy for general areas of hospital practice, covering both the prescription and monitoring of IV fluid and electrolyte therapy, and the training and educational needs of all hospital staff involved in IV fluid management.
The aim of this NICE guideline is to help prescribers understand the:
- physiological principles that underpin fluid prescribing
- pathophysiological changes that affect fluid balance in disease states
- indications for IV fluid therapy
- reasons for the choice of the various fluids available and
- principles of assessing fluid balance.
In developing the guideline, it was necessary to limit the scope by excluding patient groups with more specialised fluid prescribing needs. It is important to emphasise that the recommendations do not apply to patients under 16 years, pregnant women, and those with severe liver or renal disease, diabetes or burns. They also do not apply to patients needing inotropes and those on intensive monitoring, and so they have less relevance to intensive care settings and patients during surgical anaesthesia. Patients with traumatic brain injury (including patients needing neurosurgery) are also excluded. The scope of the guideline does not cover the practical aspects of administration (as opposed to the prescription) of IV fluids.
It is hoped that this guideline will lead to better fluid prescribing in hospitalised patients, reduce morbidity and mortality, and lead to better patient outcomes.
Strategies for further research into the subject have also been proposed.
The guideline will assume that prescribers will use a drug’s summary of product characteristics to inform decisions made with individual patients.
Patient-centred care
This guideline offers best practice advice on the care of people over 16 years who are in hospital receiving intravenous fluid therapy.
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. Healthcare professionals should follow the Department of Health’s advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
NICE has produced guidance on the components of good patient experience in adult NHS services. All healthcare professionals should follow the recommendations in patient experience in adult NHS services.
Key priorities for implementation
The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.
Principles and protocols for intravenous fluid therapy
- When prescribing IV fluids, remember the 5 Rs: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment.
- Offer IV fluid therapy as part of a protocol (see Algorithms for IV fluid therapy):
- —
Assess patients’ fluid and electrolyte needs following Algorithm 1: Assessment.
- —
If patients need IV fluids for fluid resuscitation, follow Algorithm 2: Fluid resuscitation.
- —
If patients need IV fluids for routine maintenance, follow Algorithm 3: Routine maintenance.
- —
If patients need IV fluids to address existing deficits or excesses, ongoing abnormal losses or abnormal fluid distribution, follow Algorithm 4: Replacement and redistribution.
- Patients should have an IV fluid management plan, which should include details of:
- —
the fluid and electrolyte prescription over the next 24 hours
- —
the assessment and monitoring plan.
Initially, the IV fluid management plan should be reviewed by an expert daily. IV fluid management plans for patients on longer-term IV fluid therapy whose condition is stable may be reviewed less frequently.
Assessment and monitoring
- Assess the patient’s likely fluid and electrolyte needs from their history, clinical examination, current medications, clinical monitoring and laboratory investigations:
- —
History should include any previous limited intake, thirst, the quantity and composition of abnormal losses (see Diagram of ongoing losses), and any comorbidities, including patients who are malnourished and at risk of refeeding syndrome (see Nutrition support in adults [NICE clinical guideline 32]).
- —
Clinical examination should include an assessment of the patient’s fluid status, including:
- ◊
pulse, blood pressure, capillary refill and jugular venous pressure
- ◊
presence of pulmonary or peripheral oedema
- ◊
presence of postural hypotension.
- —
Clinical monitoring should include current status and trends in:
- ◊
National Early Warning Score (NEWS)
- ◊
fluid balance charts
- ◊
weight.
- —
Laboratory investigations should include current status and trends in:
- ◊
full blood count
- ◊
urea, creatinine and electrolytes.
- All patients continuing to receive IV fluids need regular monitoring. This should initially include at least daily reassessments of clinical fluid status, laboratory values (urea, creatinine and electrolytes) and fluid balance charts, along with weight measurement twice weekly. Be aware that:
- —
Patients receiving IV fluid therapy to address replacement or redistribution problems may need more frequent monitoring.
- —
Additional monitoring of urinary sodium may be helpful in patients with high-volume gastrointestinal losses. (Reduced urinary sodium excretion [less than 30 mmol/l] may indicate total body sodium depletion even if plasma sodium levels are normal. Urinary sodium may also indicate the cause of hyponatraemia, and guide the achievement of a negative sodium balance in patients with oedema. However, urinary sodium values may be misleading in the presence of renal impairment or diuretic therapy.)
- —
Patients on longer-term IV fluid therapy whose condition is stable may be monitored less frequently, although decisions to reduce monitoring frequency should be detailed in their IV fluid management plan.
- Clear incidents of fluid mismanagement (for example, unnecessarily prolonged dehydration or inadvertent fluid overload due to IV fluid therapy) should be reported through standard critical incident reporting to encourage improved training and practice (see Consequences of fluid mismanagement to be reported as critical incidents).
Resuscitation
- If patients need IV fluid resuscitation, use crystalloids that contain sodium in the range 130–154 mmol/l, with a bolus of 500 ml over less than 15 minutes. (For more information, see the Composition of commonly used crystalloids table.)
Routine maintenance
- If patients need IV fluids for routine maintenance alone, restrict the initial prescription to:
- —
25–30 ml/kg/day of water and
- —
approximately 1 mmol/kg/day of potassium[1], sodium and chloride and
- —
approximately 50–100 g/day of glucose to limit starvation ketosis. (This quantity will not address patients’ nutritional needs; see Nutrition support in adults [NICE clinical guideline 32].)
For more information see IV fluid prescription for routine maintenance over a 24-hour period.
Training and education
- Hospitals should establish systems to ensure that all healthcare professionals involved in prescribing and delivering IV fluid therapy are trained on the principles covered in this guideline, and are then formally assessed and reassessed at regular intervals to demonstrate competence in:
- —
understanding the physiology of fluid and electrolyte balance in patients with normal physiology and during illness
- —
assessing patients’ fluid and electrolyte needs (the 5 Rs: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment)
- —
assessing the risks, benefits and harms of IV fluids
- —
prescribing and administering IV fluids
- —
monitoring the patient response
- —
evaluating and documenting changes and
- —
taking appropriate action as required.
- Hospitals should have an IV fluids lead, responsible for training, clinical governance, audit and review of IV fluid prescribing and patient outcomes.
1. Recommendations
The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance.
Terms used in this guideline
- expert
a healthcare professional who has core competencies to diagnose and manage acute illness. These competencies can be delivered by a variety of models at a local level, such as a critical care outreach team, a hospital-at-night team or a specialist trainee in an acute medical or surgical specialty. For more information, see Acutely ill patients in hospital (NICE clinical guideline 50).
1.1. Principles and protocols for intravenous fluid therapy
The assessment and management of patients’ fluid and electrolyte needs is fundamental to good patient care.
- 1.1.1.
Assess and manage patients’ fluid and electrolyte needs as part of every ward review. Provide intravenous (IV) fluid therapy only for patients whose needs cannot be met by oral or enteral routes, and stop as soon as possible.
- 1.1.2.
Skilled and competent healthcare professionals should prescribe and administer IV fluids, and assess and monitor patients receiving IV fluids (see recommendations 1.6.1–1.6.3).
- 1.1.3.
When prescribing IV fluids, remember the 5 Rs: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment.
- 1.1.4.
Offer IV fluid therapy as part of a protocol (see Algorithms for IV fluid therapy):
- Assess patients’ fluid and electrolyte needs following Algorithm 1: Assessment.
- If patients need IV fluids for fluid resuscitation, follow Algorithm 2: Fluid resuscitation.
- If patients need IV fluids for routine maintenance, follow Algorithm 3: Routine maintenance.
- If patients need IV fluids to address existing deficits or excesses, ongoing abnormal losses or abnormal fluid distribution, follow Algorithm 4: Replacement and redistribution.
Algorithms for IV fluid therapy
Download the PDF here.
- 1.1.5.
Include the following information in IV fluid prescriptions:
- The type of fluid to be administered.
- The rate and volume of fluid to be administered.
- 1.1.6.
Patients should have an IV fluid management plan, which should include details of:
- the fluid and electrolyte prescription over the next 24 hours
- the assessment and monitoring plan.
Initially, the IV fluid management plan should be reviewed by an expert daily. IV fluid management plans for patients on longer-term IV fluid therapy whose condition is stable may be reviewed less frequently.
- 1.1.7.
When prescribing IV fluids and electrolytes, take into account all other sources of fluid and electrolyte intake, including any oral or enteral intake, and intake from drugs, IV nutrition, blood and blood products.
- 1.1.8.
Patients have a valuable contribution to make to their fluid balance. If a patient needs IV fluids, explain the decision, and discuss the signs and symptoms they need to look out for if their fluid balance needs adjusting. If possible or when asked, provide written information (for example, NICE’s Information for the public), and involve the patient’s family members or carers (as appropriate).
1.2. Assessment and monitoring
Initial assessment
- 1.2.1.
Assess whether the patient is hypovolaemic. Indicators that a patient may need urgent fluid resuscitation include:
- systolic blood pressure is less than 100 mmHg
- heart rate is more than 90 beats per minute
- capillary refill time is more than 2 seconds or peripheries are cold to touch
- respiratory rate is more than 20 breaths per minute
- National Early Warning Score (NEWS) is 5 or more
- passive leg raising suggests fluid responsiveness[2].
- 1.2.2.
Assess the patient’s likely fluid and electrolyte needs from their history, clinical examination, current medications, clinical monitoring and laboratory investigations:
- History should include any previous limited intake, thirst, the quantity and composition of abnormal losses (see Diagram of ongoing losses), and any comorbidities, including patients who are malnourished and at risk of refeeding syndrome (see Nutrition support in adults [NICE clinical guideline 32]).
- Clinical examination should include an assessment of the patient’s fluid status, including:
- —
pulse, blood pressure, capillary refill and jugular venous pressure
- —
presence of pulmonary or peripheral oedema
- —
presence of postural hypotension.
- Clinical monitoring should include current status and trends in:
- —
NEWS
- —
fluid balance charts
- —
weight.
- Laboratory investigations should include current status and trends in:
- —
full blood count
- —
urea, creatinine and electrolytes.
Reassessment
- 1.2.3.
If patients are receiving IV fluids for resuscitation, reassess the patient using the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure), monitor their respiratory rate, pulse, blood pressure and perfusion continuously, and measure their venous lactate levels and/or arterial pH and base excess according to guidance on advanced life support (Resuscitation Council [UK], 2011).
- 1.2.4.
All patients continuing to receive IV fluids need regular monitoring. This should initially include at least daily reassessments of clinical fluid status, laboratory values (urea, creatinine and electrolytes) and fluid balance charts, along with weight measurement twice weekly. Be aware that:
- Patients receiving IV fluid therapy to address replacement or redistribution problems may need more frequent monitoring.
- Additional monitoring of urinary sodium may be helpful in patients with high-volume gastrointestinal losses. (Reduced urinary sodium excretion [less than 30 mmol/l] may indicate total body sodium depletion even if plasma sodium levels are normal. Urinary sodium may also indicate the cause of hyponatraemia, and guide the achievement of a negative sodium balance in patients with oedema. However, urinary sodium values may be misleading in the presence of renal impairment or diuretic therapy.)
- Patients on longer-term IV fluid therapy whose condition is stable may be monitored less frequently, although decisions to reduce monitoring frequency should be detailed in their IV fluid management plan.
- 1.2.5.
If patients have received IV fluids containing chloride concentrations greater than 120 mmol/l (for example, sodium chloride 0.9%), monitor their serum chloride concentration daily. If patients develop hyperchloraemia or acidaemia, reassess their IV fluid prescription and assess their acid-base status. Consider less frequent monitoring for patients who are stable.
- 1.2.6.
Clear incidents of fluid mismanagement (for example, unnecessarily prolonged dehydration or inadvertent fluid overload due to IV fluid therapy) should be reported through standard critical incident reporting to encourage improved training and practice (see Consequences of fluid mismanagement to be reported as critical incidents).
- 1.2.7.
If patients are transferred to a different location, reassess their fluid status and IV fluid management plan on arrival in the new setting.
1.3. Resuscitation
- 1.3.1.
If patients need IV fluid resuscitation, use crystalloids that contain sodium in the range 130–154 mmol/l, with a bolus of 500 ml over less than 15 minutes. (For more information, see the Composition of commonly used crystalloids table.)
- 1.3.2.
Do not use tetrastarch for fluid resuscitation.
- 1.3.3.
Consider human albumin solution 4–5% for fluid resuscitation only in patients with severe sepsis.
1.4. Routine maintenance
- 1.4.1.
If patients need IV fluids for routine maintenance alone, restrict the initial prescription to:
- 25–30 ml/kg/day of water and
- approximately 1 mmol/kg/day of potassium[3], sodium and chloride and
- approximately 50–100 g/day of glucose to limit starvation ketosis. (This quantity will not address patients’ nutritional needs; see Nutrition support in adults [NICE clinical guideline 32].)
For more information see IV fluid prescription for routine maintenance over a 24-hour period.
- 1.4.2.
For patients who are obese, adjust the IV fluid prescription to their ideal body weight. Use lower range volumes per kg (patients rarely need more than a total of 3 litres of fluid per day) and seek expert help if their BMI is more than 40 kg/m2.
- 1.4.3.
Consider prescribing less fluid (for example, 20–25 ml/kg/day fluid) for patients who:
- are older or frail
- have renal impairment or cardiac failure
- are malnourished and at risk of refeeding syndrome (see Nutrition support in adults [NICE clinical guideline 32]).
- 1.4.4.
When prescribing for routine maintenance alone, consider using 25–30 ml/kg/day sodium chloride 0.18% in 4% glucose with 27 mmol/l potassium[3] on day 1 (there are other regimens to achieve this). Prescribing more than 2.5 litres per day increases the risk of hyponatraemia. These are initial prescriptions and further prescriptions should be guided by monitoring.
- 1.4.5.
Consider delivering IV fluids for routine maintenance during daytime hours to promote sleep and wellbeing.
1.5. Replacement and redistribution
- 1.5.1.
Adjust the IV prescription (add to or subtract from maintenance needs) to account for existing fluid and/or electrolyte deficits or excesses, ongoing losses (see Diagram of ongoing losses) or abnormal distribution.
- 1.5.2.
Seek expert help if patients have a complex fluid and/or electrolyte redistribution issue or imbalance, or significant comorbidity, for example:
- gross oedema
- severe sepsis
- hyponatraemia or hypernatraemia
- renal, liver and/or cardiac impairment
- post-operative fluid retention and redistribution
- malnourished and refeeding issues (see Nutrition support in adults [NICE clinical guideline 32]).
1.6. Training and education
- 1.6.1.
Hospitals should establish systems to ensure that all healthcare professionals involved in prescribing and delivering IV fluid therapy are trained on the principles covered in this guideline, and are then formally assessed and reassessed at regular intervals to demonstrate competence in:
- understanding the physiology of fluid and electrolyte balance in patients with normal physiology and during illness
- assessing patients’ fluid and electrolyte needs (the 5 Rs: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment)
- assessing the risks, benefits and harms of IV fluids
- prescribing and administering IV fluids
- monitoring the patient response
- evaluating and documenting changes and
- taking appropriate action as required.
- 1.6.2.
Healthcare professionals should receive training and education about, and be competent in, recognising, assessing and preventing consequences of mismanaged IV fluid therapy, including:
- pulmonary oedema
- peripheral oedema
- volume depletion and shock.
- 1.6.3.
Hospitals should have an IV fluids lead, responsible for training, clinical governance, audit and review of IV fluid prescribing and patient outcomes.
Diagram of ongoing losses
Download the PDF here.
Source: Copyright – National Clinical Guideline Centre
Consequences of fluid mismanagement to be reported as critical incidents
| Consequence of fluid mismanagement | Identifying features | Time frame of identification |
|---|---|---|
| Hypovolaemia |
| Before and during IV fluid therapy |
| Pulmonary oedema (breathlessness during infusion) |
| During IV fluid therapy or within 6 hours of stopping IV fluids |
| Hyponatraemia |
| During IV fluid therapy or within 24 hours of stopping IV fluids |
| Hypernatraemia |
| During IV fluid therapy or within 24 hours of stopping IV fluids |
| Peripheral oedema |
| During IV fluid therapy or within 24 hours of stopping IV fluids |
| Hyperkalaemia |
| During IV fluid therapy or within 24 hours of stopping IV fluids |
| Hypokalaemia |
| During IV fluid therapy or within 24 hours of stopping IV fluids |
Source: This table was drafted based on the consensus decision of the members of the Guideline Development Group. Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24-hour period). Potassium should not be added to intravenous fluid bags as this is dangerous.
IV fluid prescription (by body weight) for routine maintenance over a 24-hour period
| Body weight | Water | Sodium, chloride, potassium |
|---|---|---|
| kg | 25–30 ml/kg/day | approx. 1 mmol/kg/day of each |
| 40 | 1000–1200 | 40 |
| 41 | 1025–1230 | 41 |
| 42 | 1050–1260 | 42 |
| 43 | 1075–1290 | 43 |
| 44 | 1100–1320 | 44 |
| 45 | 1125–1350 | 45 |
| 46 | 1150–1380 | 46 |
| 47 | 1175–1410 | 47 |
| 48 | 1200–1440 | 48 |
| 49 | 1225–1470 | 49 |
| 50 | 1250–1500 | 50 |
| 51 | 1275–1530 | 51 |
| 52 | 1300–1560 | 52 |
| 53 | 1325–1590 | 53 |
| 54 | 1350–1620 | 54 |
| 55 | 1375–1650 | 55 |
| 56 | 1400–1680 | 56 |
| 57 | 1425–1710 | 57 |
| 58 | 1450–1740 | 58 |
| 59 | 1475–1770 | 59 |
| 60 | 1500–1800 | 60 |
| 61 | 1525–1830 | 61 |
| 62 | 1550–1860 | 62 |
| 63 | 1575–1890 | 63 |
| 64 | 1600–1920 | 64 |
| 65 | 1625–1950 | 65 |
| 66 | 1650–1980 | 66 |
| 67 | 1675–2010 | 67 |
| 68 | 1700–2040 | 68 |
| 69 | 1725–2070 | 69 |
| 70 | 1750–2100 | 70 |
| 71 | 1775–2130 | 71 |
| 72 | 1800–2160 | 72 |
| 73 | 1825–2190 | 73 |
| 74 | 1850–2220 | 74 |
| 75 | 1875–2250 | 75 |
| 76 | 1900–2280 | 76 |
| 77 | 1925–2310 | 77 |
| 78 | 1950–2340 | 78 |
| 79 | 1975–2370 | 79 |
| 80 | 2000–2400 | 80 |
| 81 | 2025–2430 | 81 |
| 82 | 2050–2460 | 82 |
| 83 | 2075–2490 | 83 |
| 84 | 2100–2520 | 84 |
| 85 | 2125–2550 | 85 |
| 86 | 2150–2580 | 86 |
| 87 | 2175–2610 | 87 |
| 88 | 2200–2640 | 88 |
| 89 | 2225–2670 | 89 |
| 90 | 2250–2700 | 90 |
| 91 | 2275–2730 | 91 |
| 92 | 2300–2760 | 92 |
| 93 | 2325–2790 | 93 |
| 94 | 2350–2820 | 94 |
| 95 | 2375–2850 | 95 |
| 96 | 2400–2880 | 96 |
| 97 | 2425–2910 | 97 |
| 98 | 2450–2940 | 98 |
| 99 | 2475–2970 | 99 |
| 100 | 2500–3000 | 100 |
| >100 | 2500–3000 | 100 |
|
Add 50–100 grams/day glucose (e.g. glucose 5% contains 5g/100ml). For special considerations refer to the recommendations for routine maintenance. Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24-hour period). Potassium should not be added to intravenous fluid bags as this is dangerous. | ||
Source: This table was drafted based on the consensus decision of the members of the Guideline Development Group.
More information
You can also see this guideline in the NICE pathways on intravenous fluid therapy in hospital and sepsis.
To find out what NICE has said on topics related to this guideline, see our web page on hospitals.
See also the guideline committee’s discussion and the evidence reviews (in the full guideline), and information about how the guideline was developed, including details of the committee.
2. Research recommendations
The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The Guideline Development Group’s full set of research recommendations is detailed in the full guideline.
2.1. Assessment and monitoring
What is the incidence of complications during, and as a consequence of, IV fluid therapy?
Why this is important
This is almost certainly under-reported in the ward setting with significant implications for patients, predominantly morbidity through to mortality. It is probable that complications of fluid therapy are frequent and may be associated with increased clinical needs, such as critical care and, on occasion, may necessitate fluid resuscitation. Lack of a set of clearly defined features of the complications of fluid mismanagement compounds the problem. It is important to define these features and then undertake an observational study in a hospital setting to determine the epidemiology of these complications. Such a study would highlight the prevalence of fluid related complications and inform the development of preventive measures.
Update information
May 2017: Some research recommendations that had become outdated since original publication were stood down and deleted.
December 2016: A footnote was added to recommendations 1.4.1 and 1.4.4, the tables on ‘Consequences of fluid mismanagement to be reported as critical incidents’ and ‘IV fluid prescription (by body weight) for routine maintenance over a 24 hour period’ and the accompanying algorithms giving more information on weight-based potassium prescriptions.
Footnotes
- [1]
Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24-hour period). Potassium should not be added to intravenous fluid bags as this is dangerous.
- [2]
Passive leg raising is a bedside method to assess fluid responsiveness in a patient. It is best undertaken with the patient initially semi-recumbent and then tilting the entire bed through 45° Alternatively it can be done by lying the patient flat and passively raising their legs to greater than 45°. If, at 30–90 seconds, the patient shows signs of haemodynamic improvement, it indicates that volume replacement may be required. If the condition of the patient deteriorates, in particular breathlessness, it indicates that the patient may be fluid overloaded.
- [3]
Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24-hour period). Potassium should not be added to intravenous fluid bags as this is dangerous.
Your responsibility: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Created: December 10, 2013; Last Update: May 2017.
- Review Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital[ 2013]Review Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in HospitalNational Clinical Guideline Centre (UK). 2013 Dec
- Sepsis Care Pathway 2019.[Qatar Med J. 2019]Sepsis Care Pathway 2019.Labib A. Qatar Med J. 2019; 2019(2):4. Epub 2019 Nov 7.
- The future of Cochrane Neonatal.[Early Hum Dev. 2020]The future of Cochrane Neonatal.Soll RF, Ovelman C, McGuire W. Early Hum Dev. 2020 Nov; 150:105191. Epub 2020 Sep 12.
- Review Inappropriate prescribing of intravenous fluid in adult inpatients-a literature review of current practice and research.[J Clin Pharm Ther. 2015]Review Inappropriate prescribing of intravenous fluid in adult inpatients-a literature review of current practice and research.Gao X, Huang KP, Wu HY, Sun PP, Yan JJ, Chen J, Chen X. J Clin Pharm Ther. 2015 Oct; 40(5):489-495. Epub 2015 Jun 11.
- Critical Care Network in the State of Qatar.[Qatar Med J. 2019]Critical Care Network in the State of Qatar.Hijjeh M, Al Shaikh L, Alinier G, Selwood D, Malmstrom F, Hassan IF. Qatar Med J. 2019; 2019(2):2. Epub 2019 Nov 7.
- Intravenous fluid therapy in adults in hospitalIntravenous fluid therapy in adults in hospital
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