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” in the original guideline document.) 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, sodium and chloride and Approximately 50–100 g/day of glucose to limit starvation ketosis. (This quantity will not address patients’ nutritional needs; see the NICE guideline Nutrition support in adults External Web Site Policy [NICE clinical guideline 32]) For more information see “IV fluid prescription for routine maintenance over a 24-hour period” in the original guideline document. 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. Implementation Tools Audit Criteria/Indicators Clinical Algorithm Mobile Device Resources Patient Resources For information about availability, see the Availability of Companion Documents and Patient Resources fields below. Institute of Medicine (IOM) National Healthcare Quality Report Categories IOM Care Need Getting Better IOM Domain Effectiveness Safety Identifying Information and Availability Bibliographic Source(s) National Clinical Guideline Centre. Intravenous fluid therapy in adults in hospital. London (UK): National Institute for Health and Care Excellence (NICE); 2013 Dec. 36 p. (Clinical guideline; no. 174). Adaptation Not applicable: The guideline was not adapted from another source. Date Released 2013 Dec Guideline Developer(s) National Guideline Centre – National Government Agency [Non-U.S.] Source(s) of Funding National Institute for Health and Care Excellence (NICE) Guideline Committee Guideline Development Group Composition of Group That Authored the Guideline Development Group Members: Michael Stroud (Chair), Consultant in Gastroenterology and General (internal) Medicine, Southampton University Hospitals NHS Trust; Reem Al-Jayyousi, Consultant Nephrologist, Leicester General Hospital; Paul Cook, Consultant in Chemical Pathology, Southampton University Hospitals NHS Trust; Richard Leach, Consultant Physician in Respiratory and Critical Care, Guy’s and St Thomas’ Hospital Foundation Trust, London; Dileep Lobo, Professor of Gastrointestinal Surgery, Nottingham University Hospital; Tom McLoughlin-Yip, Patient and care giver member, Michael Mythen (GDG member until October 2012), Professor of Anesthetics and Critical Care, University College London; Patrick Nee, Consultant in Emergency Medicine and Critical Care Medicine, Whiston Hospital, Prescot, Merseyside; Jerry Nolan (GDG member from October 2012), Consultant in Intensive Care and Anesthetics, Royal United Hospital NHS Trust, Bath; Fleur North, Patient and care giver member; Katie Scales, Consultant Nurse Critical Care (Outreach), Imperial College Healthcare NHS Trust, London; Rebecca Sherratt, Advanced Nurse Practitioner, Sheffield Teaching Hospitals Trust; Neil Soni, Consultant in Intensive Care and Anesthetics, Chelsea and Westminster Hospital, London; Mark Tomlin, Consultant Pharmacist in Critical Care, Southampton General Hospital Financial Disclosures/Conflicts of Interest At the start of the guideline development process all Guideline Development Group (GDG) members declared interests including consultancies, fee-paid work, share-holdings, fellowships and support from the healthcare industry. At all subsequent GDG meetings, members declared arising conflicts of interest, which were also recorded in Appendix B in the full version of the guideline document (see the “Availability of Companion Documents” field). Members were either required to withdraw completely or for part of the discussion if their declared interest made it appropriate.
