IV FLUIDS

IV FLUIDS & DAILY REQUIREMENTS (2)

This fluid chart belongs to Shasha Banks who is his nil by mouth as she is awaiting surgery. She is fit and healthy otherwise. She needs maintenance fluids. You are the Foundation Year 1 Doctor on the surgical ward. Her U&E and creatinine are within normal limits. She weighs about 72 kg, and her observations are within normal limits.

Mutliple Choice Question

Assuming she is adequately hydrated and needs fluids only for maintenance purposes, what types of fluid should you prescribe in D, E and F?

Would she need additives in G,H and I? If yes, which additives?

Mutliple Choice Question

Assuming each of your chosen fluid comes in 1 Litre bags, at what rate will you administer the fluids?

Open Question

How will you assess her fluid requirements post surgery to avoid overload?

Teacher's Comment

Why is fluid prescription so important?


Evidence show that Foundation Year 1 doctors are commonly responsible for fluid prescription. However, less than half of them, or their SHOs are familiar even with the sodium content of normal saline! ⁵


The 1999 Report of the National Confidential Enquiry into Perioperative Deaths raised the contribution of errors in in fluid and electrolyte management to perioperative morbidity and mortality. The report ascribes many of the errors to inadequate knowledge and training.


Epidemiologic studies of postoperative pulmonary oedema in the USA when all other associated co-morbidities have been taken into account, suggests that in 1993 alone, 8315 deaths could have resulted from pulmonary oedema in the absence of causes other than excessive fluid administration!⁶


Lesson: Intravenous infusion should not be continued as 'routine'  component of clinical care. Identify clinical reason for administering fluids, and assess volume required, before prescribing. If your patient can drink, stop their IV fluids as soon as possible and encourage oral intake.