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Intravenous fluid therapy in adults in hospital overview

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Intravenous fluid therapy in adults in hospital HAI

About

What is covered

Many adult hospital inpatients need 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. 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.
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 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.
It is hoped that the pathway will lead to better fluid prescribing in hospitalised patients, reduce morbidity and mortality, and lead to better patient outcomes.
The pathway contains recommendations about general principles for managing IV fluids, and applies to a range of conditions and different settings. It does not include recommendations relating to specific conditions.

Updates

Updates to this pathway

13 August 2014 'Intravenous fluid therapy in adults in hospital' (NICE quality standard 66) added to this pathway.
13 February 2014 Minor maintenance updates.

Patient-centred care

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. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. 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.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Short Text

Intravenous fluid therapy in adults in hospital

What is covered

Many adult hospital inpatients need 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. 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.
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 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.
It is hoped that the pathway will lead to better fluid prescribing in hospitalised patients, reduce morbidity and mortality, and lead to better patient outcomes.
The pathway contains recommendations about general principles for managing IV fluids, and applies to a range of conditions and different settings. It does not include recommendations relating to specific conditions.

Updates

Updates to this pathway

13 August 2014 'Intravenous fluid therapy in adults in hospital' (NICE quality standard 66) added to this pathway.
13 February 2014 Minor maintenance updates.

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Intravenous fluid therapy in adults in hospital. NICE clinical guideline 174 (2013)

Quality standards

Intravenous fluid therapy in adults in hospital

These quality statements are taken from the intravenous fluid therapy in adults in hospital quality standard. The quality standard defines clinical best practice in intravenous fluid therapy in adults in hospital and should be read in full.

Quality statements

Intravenous fluids lead

This quality statement is taken from the intravenous fluid therapy in adults in hospital quality standard. The quality standard defines clinical best practice in intravenous fluid therapy in adults in hospital and should be read in full.

Quality statement

Hospitals have an intravenous (IV) fluids lead who has overall responsibility for training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.

Rationale

The IV fluids lead in a hospital can promote best practice, ensuring that healthcare professionals are trained in prescribing and administering IV fluid therapy, and reviewing learning from 'near miss' and critical incident reporting. This leadership role can ensure continuity of care in relation to fluid management through coordination between different hospital departments.

Quality measures

Structure
Evidence that hospitals have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as district general hospitals and specialist care centres) ensure that they have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
Healthcare professionals who care for adults receiving IV fluid therapy in hospital work in the context of clinical governance arrangements that have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
Commissioners (such as clinical commissioning groups and NHS England Area Teams) ensure that they commission services from hospitals that have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.

What the quality statement means for patients, service users and carers

Adults receiving IV fluid therapy are cared for in a hospital that has a person who has overall responsibility for ensuring that they receive safe and effective IV fluid therapy.

Source guidance

Definition of terms used in this quality statement

Responsible IV fluids lead
The IV fluids lead will have overall responsibility, through a leadership role, for the quality of care relating to IV fluid therapy. The IV fluids lead should be somebody in a senior position (such as the chief of medicine or the chief nurse), and may delegate specific functions through normal governance structures. The IV fluids lead is not expected to be the person who delivers the training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes. Those functions can be delegated to professionals who have the necessary specialist knowledge in the hospital. [Expert opinion]
Training
Training in fluid management should also be embedded in both general and specialty training programmes, with clear curriculum-based teaching objectives and delineation of minimum standards of clinical competency and knowledge for each stage of training and clinical delivery. Recognition and management of the clinical complications of fluid management should also be considered. [NICE clinical guideline 174]
Training in prescribing and administering IV fluids can be supported by the online e-learning module that supports the implementation of NICE clinical guideline 174. The e‑learning module uses interactive activities to support prescribers to safely assess, prescribe for and review adults needing IV fluids. The tool may also be useful for trainee prescribers to enhance their knowledge base before they start prescribing practice.

Healthcare professionals' competencies in hospitals

This quality statement is taken from the intravenous fluid therapy in adults in hospital quality standard. The quality standard defines clinical best practice in intravenous fluid therapy in adults in hospital and should be read in full.

Quality statement

Adults receiving intravenous (IV) fluid therapy in hospital are cared for by healthcare professionals competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response.

Rationale

Fluid assessment, prescription and administration are essential daily tasks in many hospital departments. These are complex responsibilities that entail careful clinical and biochemical assessment, good understanding of the principles of fluid physiology in health and disease, and appropriate supervision and training. Inadequate knowledge, failure to recognise the importance of fluid management in patient care and acting on this issue are major factors in poor fluid management, and poor education, training and supervision are major contributors. Different healthcare professionals will have different skills and competencies, relevant to their roles.

Quality measures

Structure
Evidence of local arrangements to ensure that adults receiving IV fluid therapy in hospital are cared for by healthcare professionals who are competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response.
Data source: Local data collection.
Process
a) Proportion of healthcare professionals who are responsible for prescribing IV fluid therapy in hospital who are able to demonstrate competency in prescribing IV fluids.
Numerator – the number of healthcare professionals in the denominator who are able to demonstrate competency in prescribing IV fluids.
Denominator – the number of healthcare professionals who are responsible for prescribing IV fluid therapy in hospital.
Data source: Local data collection.
b) Proportion of healthcare professionals who are responsible for administering IV fluid therapy in hospital who are able to demonstrate competency in administering IV fluids.
Numerator – the number of healthcare professionals in the denominator who are able to demonstrate competency in administering IV fluids.
Denominator – the number of healthcare professionals who are responsible for administering IV fluid therapy in hospital.
Data source: Local data collection.
c) Proportion of healthcare professionals who are caring for adults on IV fluid therapy who are able to demonstrate competency in monitoring patient response.
Numerator – the number of healthcare professionals in the denominator who are able to demonstrate competency in monitoring patient response.
Denominator – the number of healthcare professionals who are monitoring adults on IV fluid therapy.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as district general hospitals and specialist care centres) ensure that systems are in place to ensure that adults receiving IV fluid therapy in hospital are cared for by a team of healthcare professionals competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response.
Healthcare professionals involved in prescribing and delivering IV fluid therapy can demonstrate competence in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response. Different healthcare professionals will have different skills and competencies, relevant to their roles.
Commissioners (clinical commissioning groups and NHS England area teams) ensure that they commission services from hospitals that are able to demonstrate that relevant healthcare professionals are competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response. This can be achieved by requiring providers to supply training numbers for staff who have been trained and staff who have been assessed.

What the quality statement means for patients, service users and carers

Adults receiving IV fluid therapy in hospital are cared for by a team of healthcare professionals who have the knowledge and skills to ensure that they receive safe and effective IV fluid therapy.

Source guidance

Definitions of terms used in this quality statement

Competencies of a team of healthcare professionals
Hospitals should establish systems to ensure that all healthcare professionals involved in prescribing and delivering IV fluid therapy are trained on intravenous therapy principles covered in NICE clinical guideline 174, 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.
Competency needs to be tailored to the professional role, and may vary according to professional roles. For example, competency for senior clinicians will include active involvement in reviewing patients' fluid management plans, providing leadership to the junior team to ensure quality care.
Competency, in the context of this quality statement, includes IV fluid competencies relevant to people who are having total parenteral nutrition (TPN) but not competencies relating to the nutritional element of prescribing.
[Adapted from NICE clinical guideline 174, recommendation 1.6.1]

Intravenous fluid management plan

This quality statement is taken from the intravenous fluid therapy in adults in hospital quality standard. The quality standard defines clinical best practice in intravenous fluid therapy in adults in hospital and should be read in full.

Quality statement

Adults receiving intravenous (IV) fluid therapy in hospital have an IV fluid management plan, determined by and reviewed by an expert, which includes the fluid and electrolyte prescription over the next 24 hours and arrangements for assessing patients and monitoring their plan.

Rationale

Hospital inpatients may need IV fluid and electrolytes for fluid resuscitation, routine maintenance, replacement of existing deficits or abnormal ongoing losses, or complex issues of fluid redistribution. Patients' needs for IV fluid therapy and their responses to it will vary. Careful monitoring and daily assessment, informed by communication between the expert and patients, should therefore be detailed in an IV fluid management plan in the medical record.

Quality measures

Structure
Evidence of local arrangements to ensure that adults receiving IV fluid therapy in hospital have an IV fluid management plan, determined by and reviewed by an expert, which includes the fluid and electrolyte prescription for the next 24 hours and arrangements for assessing patients and monitoring their plan.
Data source: Local data collection.
Process
Proportion of adults receiving IV fluid therapy in hospital who had an IV fluid management plan, determined by and reviewed by an expert, which included daily review of the fluid and electrolyte prescription and arrangements for assessing the patient and monitoring their plan.
Numerator – the number of adults in the denominator who had an IV fluid management plan determined by and reviewed by an expert, which included daily review of the fluid and electrolyte prescription and arrangements for assessing the patient and monitoring their plan.
Denominator – the number of adults receiving IV fluid therapy in hospital.
Data source: Local data collection. Data can also be collected using the NICE clinical guideline 174 clinical audit tool, standards 3 and 4.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as district general hospitals and specialist care centres) ensure that systems are in place for IV fluid management plans to be determined by and reviewed by an expert; plans should include prescriptions over the next 24 hours and arrangements for assessing patients and monitoring their plan.
Healthcare professionals, who are responsible for adults who are receiving IV fluid therapy in hospital,ensure that they determine and review an IV fluid management plan, which includes the fluid and electrolyte prescription for the next 24 hours and arrangements for assessing patients and monitoring their plan.
Commissioners (clinical commissioning groups and NHS England area teams) ensure they commission inpatient services for adults so that IV fluid therapy management plans are determined by and reviewed by an expert and include the fluid and electrolyte prescription for the next 24 hours and arrangements for assessing the patients and monitoring their plan. This can be achieved by auditing hospitals using the IV fluid audit toolkit or by monthly performance monitoring.

What the quality statement means for patients, service users and carers

Adults receiving IV fluid therapy in hospital will know that they have an IV fluid management plan that has been written by and reviewed by an expert. The plan includes the details of the patient's IV fluid prescription (what is needed over the next 24 hours and how it is to be given), as well as details of the IV fluid therapy assessments and checks that should be carried out over the next 24 hours.

Source guidance

Definitions of terms used in this quality statement

Intravenous fluid management plan
The IV fluid management plan should outline the fluid and electrolyte prescription over the next 24‑hour period. It will cover the type, rate and volume of fluid, and how it is to be given. It will be determined by an expert who prescribes IV fluid therapy. Healthcare professionals should follow the IV fluid therapy algorithms in NICE clinical guideline 174.
Assessment
Assessment of adults who are receiving IV fluid therapy will include response to the IV fluid therapy and specific checks for adverse effects of IV fluid therapy. These are described in NICE clinical guideline 174. Assessing and monitoring IV fluid therapy will involve clinical judgement supported by laboratory results.
Monitoring of the plan
The IV fluid management plan should be monitored and reviewed within appropriate timescales. Initially, it should be reviewed daily by an expert. IV fluid management plans for patients on longer-term IV fluid therapy whose condition is stable may be reviewed less frequently. Any decisions to reduce monitoring frequency should be detailed in the IV fluid management plan.
[Adapted from NICE clinical guideline 174, recommendations 1.1.4, 1.1.6, 1.1.8 and 1.2.4]
Expert
NICE clinical guideline 174 defines an expert, in this context, as 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.

Identifying and reporting consequences of fluid mismanagement

This quality statement is taken from the intravenous fluid therapy in adults in hospital quality standard. The quality standard defines clinical best practice in intravenous fluid therapy in adults in hospital and should be read in full.

Quality statement

For adults who receive intravenous (IV) fluid therapy in hospital, clear incidents of fluid mismanagement are reported as critical incidents.

Rationale

There are a number of potential adverse consequences of IV fluid therapy, including unnecessarily prolonged dehydration, over hydration or significant electrolyte imbalance, which may be identified by clinical and biochemical monitoring. Not all adverse consequences of IV fluid therapy are due to fluid mismanagement, but clinically significant problems caused by IV fluid mismanagement should be reported as critical incidents. By routinely reporting these events, even when they are well-managed, hospitals will increase learning, improving the likelihood of better patient outcomes.

Quality measures

Structure
Evidence of local arrangements to ensure that clear incidents of fluid mismanagement are reported as critical incidents for adults receiving IV fluid therapy in hospital.
Data source: Local data collection.
Process
Proportion of clear incidents of fluid mismanagement recorded for adults receiving IV fluid therapy in hospital that are reported as critical incidents.
Numerator – the number of clear incidents of fluid mismanagement in the denominator for which a critical incident is reported.
Denominator – the number of clear incidents of fluid mismanagement recorded for adults receiving IV fluid therapy in hospital.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as district general hospitals and specialist care centres) ensure that systems are in place for reporting clear incidents of fluid mismanagement as critical incidents.
Healthcare professionals who care for adults receiving IV fluid therapy in hospital should assess patients' responses to IV fluid therapy and report clear incidents of fluid mismanagement as critical incidents.
Commissioners (clinical commissioning groups and NHS England area teams) ensure that they commission services for adults receiving IV fluid therapy in hospital from providers that report clear incidents of fluid mismanagement as critical incidents. This can be achieved by ensuring that providers share lessons learned from critical incident investigations.

What the quality statement means for patients, service users and carers

Adults receiving IV fluid therapy in hospital are cared for in a hospital that has systems set in place so that IV fluid therapy problems (for example, patients not getting enough IV fluid and becoming severely dehydrated) are reported and dealt with correctly.

Source guidance

Definitions of terms used in this quality statement

Clear incidents of fluid mismanagement
The identification and reporting of incidents of fluid mismanagement should be good practice. It is better to identify and report such incidents than not to identify them, or not to report them if they are identified. Therefore, implementing the quality standard may see an initial increase in incident reporting, reflecting improved identification and reporting rather than worse practice.
Recommendation 1.2.6 (key priority for implementation) in NICE clinical guideline 174 provides the following framework for identifying and reporting adverse consequences in the context of IV fluid management based on Guideline Development Group consensus:
Consequence of fluid mismanagement
Identifying features
Time frame of identification
Hypovolaemia
  • Patient's fluid needs not met by oral, enteral or IV intake and
  • Features of dehydration on clinical examination
  • Low urine output or concentrated urine
  • Biochemical indicators, such as more than 50% increase in urea or creatinine with no other identifiable cause
Before and during IV fluid therapy
Pulmonary oedema (breathlessness during infusion)
  • No other obvious cause identified (for example, pneumonia, pulmonary embolus or asthma)
  • Features of pulmonary oedema on clinical examination
  • Features of pulmonary oedema on X‑ray
During IV fluid therapy or within 6 hours of stopping IV fluids
Hyponatraemia
  • Serum sodium less than 130 mmol/l
  • No other likely cause of hyponatraemia identified
During IV fluid therapy or within 24 hours of stopping IV fluids
Hypernatraemia
  • Serum sodium 155 mmol/l or more
  • Baseline sodium normal or low
  • IV fluid regimen included 0.9% sodium chloride
  • No other likely cause of hypernatraemia identified
During IV fluid therapy or within 24 hours of stopping IV fluids
Peripheral oedema
  • Pitting oedema in extremities and/or lumbar sacral area
  • No other obvious cause identified (for example, nephrotic syndrome or known cardiac failure)
During IV fluid therapy or within 24 hours of stopping IV fluids
Hyperkalaemia
  • Serum potassium more than 5.5 mmol/l
  • No other obvious cause identified
During IV fluid therapy or within 24 hours of stopping IV fluids
Hypokalaemia
  • Serum potassium less than 3.0 mmol/l likely to be due to infusion of fluids without adequate potassium provision
  • No other obvious cause (for example, potassium-wasting diuretics, refeeding syndrome)
During IV fluid therapy or within 24 hours of stopping IV fluids

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Patient-centred care

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. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. 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.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Supporting information

Consequences of fluid mismanagement to be reported as critical incidents

Consequence of fluid mismanagement
Identifying features
Time frame of identification
Hypovolaemia
Patient's fluid needs not met by oral, enteral or IV intake and
Before and during IV fluid therapy
* Features of dehydration on clinical examination
* Low urine output or concentrated urine
* Biochemical indicators, such as more than 50% increase in urea or creatinine with no other identifiable cause
Pulmonary oedema (breathlessness during infusion)
No other obvious cause identified (for example, pneumonia, pulmonary embolus or asthma)
During IV fluid therapy or within 6 hours of stopping IV fluids
Features of pulmonary oedema on clinical examination
Features of pulmonary oedema on X-ray
Hyponatraemia
Serum sodium less than 130 mmol/l
During IV fluid therapy or within 24 hours of stopping IV fluids
No other likely cause of hyponatraemia identified
Hypernatraemia
Serum sodium 155 mmol/l or more
During IV fluid therapy or within 24 hours of stopping IV fluids
Baseline sodium normal or low
IV fluid regimen included 0.9% sodium chloride
No other likely cause of hypernatraemia identified
Peripheral oedema
Pitting oedema in extremities and/or lumbar sacral area
During IV fluid therapy or within 24 hours of stopping IV fluids
No other obvious cause identified (for example, nephrotic syndrome or known cardiac failure)
Hyperkalaemia
Serum potassium more than 5.5 mmol/l
During IV fluid therapy or within 24 hours of stopping IV fluids
No other obvious cause identified
Hypokalaemia
Serum potassium less than 3.0 mmol/l likely to be due to infusion of fluids without adequate potassium provision
During IV fluid therapy or within 24 hours of stopping IV fluids
No other obvious cause (for example, potassium-wasting diuretics, refeeding syndrome)

IV fluid prescription (by body weight) for routine maintenance over a 24-hour period

Body weight
Water
Sodium, chloride, potassium
Body weight
Water
Sodium, chloride, potassium
kg
25–30 ml/kg/day
approx. 1 mmol/kg/day of each
kg
25–30ml/kg/day
approx. 1 mmol/kg/day of each
40
1000–1200
40
71
1775–2130
71
41
1025–1230
41
72
1800–2160
72
42
1050–1260
42
73
1825–2190
73
43
1075–1290
43
74
1850–2220
74
44
1100–1320
44
75
1875–2250
75
45
1125–1350
45
76
1900–2280
76
46
1150–1380
46
77
1925–2310
77
47
1175–1410
47
78
1950–2340
78
48
1200–1440
48
79
1975–2370
79
49
1225–1470
49
80
2000–2400
80
50
1250–1500
50
81
2025–2430
81
51
1275–1530
51
82
2050–2460
82
52
1300–1560
52
83
2075–2490
83
53
1325–1590
53
84
2100–2520
84
54
1350–1620
54
85
2125–2550
85
55
1375–1650
55
86
2150–2580
86
56
1400–1680
56
87
2175–2610
87
57
1425–1710
57
88
2200–2640
88
58
1450–1740
58
89
2225–2670
89
59
1475–1770
59
90
2250–2700
90
60
1500–1800
60
91
2275–2730
91
61
1525–1830
61
92
2300–2760
92
62
1550–1860
62
93
2325–2790
93
63
1575–1890
63
94
2350–2820
94
64
1600–1920
64
95
2375–2850
95
65
1625–1950
65
96
2400–2880
96
66
1650–1980
66
97
2425–2910
97
67
1675–2010
67
98
2450–2940
98
68
1700–2040
68
99
2475–2970
99
69
1725–2070
69
100
2500–3000
100
70
1750–2100
70
>100
2500–3000
100
Add 50–100 grams/day glucose (e.g. glucose 5% contains 5 g/100 ml).
For special considerations refer to the recommendations for routine maintenance.

Glossary

Airway, Breathing, Circulation, Disability, Exposure
body mass index
intravenous
National Early Warning Score
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.
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.

Paths in this pathway

Pathway created: December 2013 Last updated: August 2014

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