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. 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 hyperchloremia or acidemia, reassess their IV fluid prescription and assess their acid–base status. Consider less frequent monitoring for patients who are stable. 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” below). If patients are transferred to a different location, reassess their fluid status and IV fluid management plan on arrival in the new setting. 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.) Do not use tetrastarch for fluid resuscitation. Consider human albumin solution 4% to 5% for fluid resuscitation only in patients with severe sepsis. 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.
