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Intravenous Fluid Guidelines: Adults - Royal Sussex County ...

Intravenous Fluid guidelines : Adults Before Prescribing Is my patient Euvolaemic? Hypovolaemic? Hypervolaemic? Can my patient have Fluid enterally? Why does my patient need IV fluids? How much Fluid does my patient need? What type of Fluid does my patient need? Fluid Status Assessment History: Limited oral intake, abnormal losses, co-morbidities Clinical examination: Pulse, BP, capillary refill, JVP, oedema, postural hypotension, lung fields Clinical monitoring: NEWS, Fluid balance, weight, CXR Laboratory investigations: FBC, U&Es Special Considerations Obesity: Use ideal body weight. Seek senior advice if BMI>40 Frail, Elderly, CCF or Renal impairment: consider smaller volumes of maintenance Fluid (20-25mL/kg/day) Bleeding: Replace with blood products if required Diabetes or patient on VRII Routine Maintenance The Fluid of choice for patients unable to take enteral fluids but with no abnormal losses is: Sodium Chloride + Dextrose 4% + 20-40mmol/Litre of Potassium Chloride.

(e.g. vomiting, diarrhoea, high output stoma, sepsis) as required. Give sodium chloride 0.9% (+/-K l) or Hartmann’s in addition to routine maintenance fluids as expected. Adjust rate of IV fluids for current and ongoing deficits Stop routine maintenance fluids when the enteral route is Seek senior advice for complex patients Reassessment

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