IV fluid prescription – maintenance fluids key points

(Please also see NICE guidance – link on Hippocrates)

When prescribing IV fluids – remember the following points and principles:

 IV fluid prescription not always straightforward – there is no “one size fits all” approach
 Prescription needs to be written according to the individuals requirements and weight MUST
be considered
 Clinical assessment of volume and electrolyte status mandatory before writing any fluid
prescription
 IV fluid prescription must be reassessed regularly (minimum of 24 hourly).
 Don’t prescribe too much salt – 1 litre of normal saline contains almost double normal daily
requirement of 70kg patient (134mmol)consider smaller volumes of “normal” saline or
dextrose saline

KEY POINTS from NICE guidelines regarding advice for daily maintenance fluids:

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.

Consider prescribing less fluid (for example, 20–25 ml/kg/day fluid) for patients who:
 are older or frail
 have renal impairment or cardiac failure
 are malnourished and at risk of refeeding syndrome

The following hourly rate of fluid administration of litre bags of fluid is suggested as a ROUGH
practical guide (assuming BMI < 40):

Weight (kg) Daily maintenance “Rounded off” 24 Rate of

volume requirement hour requirement administration of 1
(25-30mls/kg/day), litre bags
litres
60 1.5 – 1.8 1.5 16 hourly
65 1.625 – 1.95 1.7 14 hourly
70 1.75 – 2.1 2 12 hourly
75 1.875 – 2.25 2 12 hourly
80 2 – 2.4 2 12 hourly**
85 2.125 – 2.55 2.4 10 hourly
90 2.5 – 2.7 2.67 9 hourly

** Note this is the minimum maintenance requirement for an 80kg patient – 12 hourly prescription a
bit easier to manage than an 11 hourly prescription (this would give 2.272 litres / 24hrs)