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.
Teacher's Comment
Why is fluid prescription so important? ⁵
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.