Prescribing IV Fluids

Guidelines - ADULT

3UHVFULELQJIntravenous Fluids for Adults

5HYLHZHGE\4XHHQVODQG+HDOWK0HGLFLQHV5HJXODWLRQDQG4XDOLW\
)OXLGDQG(OHFWURO\WH*XLGHOLQH:RUNLQJ3DUW\
‹7KH6WDWHRI4XHHQVODQG4XHHQVODQG+HDOWK
&RQWDFWPHGLFDWLRQVDIHW\#KHDOWKTOGJRYDX

DO NOT USE IN PAEDIATRIC PATIENTS. 5HIHUWRORFDOJXLGHOLQHVRULIQRWDYDLODEOHUHIHUWR

KWWSTKHSVKHDOWKTOGJRYDXFKLOGUHQVKHDOWKUHVRXUFHVJXLGHOLQHVJGOSGIRUGuidelines for
To remain in
Prescribing Intravenous Fluids for Paediatrics end-of-bed folder

Is the patient hypovolaemic and in *LYH5(686&,7$7,21ÀXLGVDQG

QHHGRIÀXLGUHVXVFLWDWLRQ" vasoactive agents as appropriate
Review: ‡5HIHUWRORFDOJXLGHOLQHVOR
‡&OLQLFDOH[DPLQDWLRQ%3SXOVHFDSLOODU\ LIXQDYDLODEOHIntravenous Fluid
YES
UH¿OO-93 Therapy in Adults in Hospital | Guidance and
Guidelines | NICE
‡&OLQLFDOKLVWRU\IRUVLJQVDQGV\PSWRPV
KWWSVZZZQLFHRUJXNJXLGDQFHFJ
RIÀXLGGH¿FLWRURYHUORDGWKLUVWSUHYLRXV
LQWDNHDEQRUPDOORVVHV
‡&OLQLFDOUHFRUGVODERUDWRU\UHVXOWVHJXUHD
DQGFUHDWLQLQHÀXLGEDODQFHFKDUWVXULQH
RXWSXWDQGGDLO\ZHLJKW

NO

Ensure nutrition and

Can patient meet needs
ÀXLGQHHGVDUHPHW
RUDOO\RUHQWHUDOO\" YES &RQVLGHUGLHWLWLDQUHYLHZ
NO

'RHVWKHSDWLHQWKDYHFRPSOH[ÀXLG
or electrolyte replacement
requirements or abnormal distribution
issues such as being post-operative, NO
ongoing losses, sepsis, renal, liver or
FDUGLDFLPSDLUPHQW"

YES

REPLACEMENT and 0DLQWHQDQFHÀXLGVDUHPRVW

appropriate
5(',675,%87,21ÀXLGVDUH
1RUPDOGDLO\ÀXLGDQGHOHFWURO\WH
most appropriate UHTXLUHPHQWVIRU+($/7+<DGXOWV
3DWLHQWVW\SLFDOO\UHTXLUH,62721,& ‡±P/NJGD\EDVHGRQLGHDOERG\
ÀXLGVVXFKDV ZHLJKWRIZDWHU
‡6RGLXPFKORULGH ‡PPRONJGD\VRGLXPSRWDVVLXPFKORULGH
‡±JGD\JOXFRVH
‡+DUWPDQQV
HJIRUDQDYHUDJHNJDGXOWWKLVFRXOGEH
‡3ODVPDO\WH PHWZLWKWZR/EDJVRIVRGLXPFKORULGH
DQGJOXFRVHZLWKPPRORISRWDVVLXP
SEE OVER for details DWP/KU/KRXUO\
0DW1R2I¿FH0D[1R

WHEN TO REVIEW

‡8QVWDEOHSDWLHQWVQHHGWREHUHYLHZHGDWOHDVWHYHU\±+2856$OOSDWLHQWVVKRXOGEHUHDVVHVVHG
DWOHDVW'$,/<
v5.00 - 09/2016

‡(QVXUH\RXKDYHUHTXHVWHGDVWULFWÀXLGEDODQFHFKDUWGXULQJSHULRGRI,9ÀXLGWKHUDS\
‡&RQVLGHUVORZLQJUDWHRIÀXLGLQIXVLRQRYHUQLJKWLQSDWLHQWVDWULVNRIRYHUORDG
‡6ZLWFKWRDQHQWHUDOURXWHRUDO1*3(*HWFDVVRRQDVSRVVLEOH
 Prescribing IV Fluids
Guidelines - ADULT

DO NOT USE IN PAEDIATRIC PATIENTS. 5HIHUWRORFDOJXLGHOLQHVRULIQRWDYDLODEOHUHIHUWR

KWWSTKHSVKHDOWKTOGJRYDXFKLOGUHQVKHDOWKUHVRXUFHVJXLGHOLQHVJGOSGIRUGuidelines for
To remain in
Prescribing Intravenous Fluids for Paediatrics end-of-bed folder

REPLACEMENT and REDISTRIBUTION

1. Fluid Replacement
)OXLGGH¿FLW
‡Intravascular hypovolaemia:5HSODFHZLWKÀXLGVVXFKDVVRGLXPFKORULGHRUFRPSRXQGVRGLXPODFWDWH+DUWPDQQV
,QVHOHFWHGFOLQLFDOVLWXDWLRQVDSSURSULDWHFROORLGVDOEXPLQRUVXFFLQ\ODWHGJHODWLQFRXOGEHFRQVLGHUHG6HHNDGYLFHLI
XQVXUHZKHQFROORLGVDSSURSULDWH,IKDHPRJORELQORZFRQVLGHUEORRGSURGXFWV
‡([WUDFHOOXODUGH¿FLW&RUUHFWZLWKUHSODFHPHQWÀXLGEDVHGRQW\SHRIÀXLGORVWVHHGLDJUDP,IVHUXPVRGLXPLVORZDYRLG
JOXFRVHRUJOXFRVHVDOLQHFRPELQDWLRQV$GPLQLVWHUKDOIUHTXLUHGYROXPHRYHUKRXUVDQGVHFRQGKDOIRYHUQH[WKRXUV,ISRRU
FDUGLDFUHVHUYHUHGXFHUDWHWRKDOIUHTXLUHGYROXPHRYHUKRXUVDQGVHFRQGKDOIRYHUQH[WKRXUV5HDVVHVVIUHTXHQWO\
Fluid overload
‡5HYLHZDOOÀXLGDGPLQLVWUDWLRQLQFOXGLQJ³7R.HHS9HLQ2SHQ7.92´RUGHUVDQGIRUGUXJDGPLQLVWUDWLRQ0LQLPLVHVRGLXPDQG
ÀXLGYROXPHJLYHQ&RQVLGHUGLXUHWLF
Electrolyte derangements
‡6HHPrescribing Guidelines for Electrolyte Disturbances in Adults.
2. Ongoing Abnormal Fluid Losses
‡&KHFNRQJRLQJYROXPHVDQGFRPSRVLWLRQRI
ORVVHVXVLQJGLDJUDPSURYLGHG
‡5HSODFHZLWKDSSURSULDWHÀXLG8VHTable 1 to
DLGLQÀXLGFKRLFH
Table 1: Properties of Some
Common Fluids
6RGLXP 3RWDVVLXP &KORULGH *OXFRVH
7\SHRIÀXLG
PPRO/ PPRO/ PPRO/ J/

6RGLXP
FKORULGH 154 0 154 0


&RPSRXQG
VRGLXP
129 5 109 0
ODFWDWH
+DUWPDQQV#

3ODVPDO\WH
140 5 98 0
LQZDWHU#

VRGLXP
FKORULGH
51 0 51 33
DQG
JOXFRVH

JOXFRVH 0 0 0 50

* Available as pre-mix with 20mmol or 40mmol/L

of potassium.
#
Compatibility with some medications may be an
issue. Check product information for further advice.
'LDJUDPVRXUFH1DWLRQDO*XLGHOLQH&HQWUH,QWUDYHQRXVÀXLGWKHUDS\LQDGXOWVLQKRVSLWDO&OLQLFDOJXLGHOLQH3XEOLVKHGE\WKH1DWLRQDO
&OLQLFDO*XLGHOLQH&HQWUHDW7KH5R\DO&ROOHJHRI3K\VLFLDQV6W$QGUHZV3ODFH5HJHQW¶V3DUN/RQGRQ1:/(&RS\ULJKW‹1*&5HSURGXFHG
E\SHUPLVVLRQ$ODUJHUGLDJUDPLVDYDLODEOHDWKWWSVZZZQLFHRUJXNJXLGDQFHFJUHVRXUFHVGLDJUDPRIRQJRLQJORVVHV

3. Redistribution and Other Complex Issues

‡3RVWRSÀXLGUHWHQWLRQDQGUHGLVWULEXWLRQ)OXLGVZLWKDKLJKHUVRGLXPFRQFHQWUDWLRQDWUHGXFHGYROXPHVDUHLQGLFDWHG
HJVRGLXPFKORULGHDW±P/KULQDHXYRODHPLFSDWLHQW&RQVLGHUDGGLQJSRWDVVLXPPPRO/IURPGD\RU
‡Impaired cardiac function:3DWLHQWVDUHDWLQFUHDVHGULVNRIÀXLGRYHUORDG5HGXFHYROXPHJLYHQDQGPRQLWRUIUHTXHQWO\
‡Impaired renal function: 3DWLHQWVPD\EHDWLQFUHDVHGULVNRIRYHUORDGK\SHUNDODHPLDIf oliguric, do not use potassium.
)RUhypovolaemiaFRUUHFWDVSHUÀXLGGH¿FLWDERYH)RUeuvolaemiaOLPLWYROXPHWRXULQHYRORWKHUORVVHVP/SHUGD\
‡Septic patients:+DYHYDULDEOHLQFUHDVHGÀXLGUHTXLUHPHQWV9DVRSUHVVRUVXSSRUWLQ,&8PD\EHUHTXLUHG Seek advice.
‡Obese: $GMXVWHVWLPDWHGÀXLGUHTXLUHPHQWVDQGHOHFWURO\WHGRVHVEDVHGRQLGHDOERG\ZHLJKW,I%0,LVJUHDWHUWKDQNJP2
VHHNH[SHUWDGYLFH
‡Smaller/Geriatric patients: 3URSRUWLRQDWHUHGXFWLRQVLQGLFDWHGDo not use these guidelines in paediatrics.
‡6SHFL¿FÀXLGUHTXLUHPHQWV3DWLHQWVRQGLDO\VLVZLWKEXUQVOLYHUGLVHDVHWUDQVSODQWVDFXWHQHXURORJLFDOFRQGLWLRQV
PHQLQJLWLVHQFHSKDOLWLVDQGVWURNHGLDEHWLFNHWRDFLGRVLVRUK\SHURVPRODUK\SHUJO\FDHPLFVWDWHKDYHYHU\VSHFL¿FÀXLG
UHTXLUHPHQWVSeek advice.