DRAFT FOR CONSULTATION

Algorithms for IV fluid the rapy

Algo rithm 1: As s e s s me nt

Do e s the patie nt ne e d fluid re s us citatio n?

Assess volume status taking into account clinical examination, trends and context. Possible indicators include: systolic BP <100mmHg; heart rate >90bpm; capillary refill >2s or
peripheries cold to touch; respiratory rate >20 breaths per min; NEWS ≥5; 45o passive leg raising test positive.

Yes
No
Yes
Ens ure nutritio n and fluid ne e ds are me t.
Algo rithm 2: Re s us c itatio n Can the patie nt me e t the ir fluid and/o r e le c tro lyte ne e ds o rally o r e nte rally? Also see ‘Nutrition support in adults’ (NICE
clinical guideline 32).
No
Initiate tre atme nt
Give high-flow oxygen. As s e s s the patie nt’s like ly fluid and elec tro lyte nee ds
Secure large bore IV access. History: previous limited intake, abnormal losses, comorbidities.
Identify cause of deficit and respond. Clinical examination: pulse, BP, capillary refill, JVP, oedema (peripheral/pulmonary), postural hypotension.
Clinical monitoring: NEWS, fluid balance charts, weight.
Laboratory assessments: FBC, urea, creatinine and electrolytes.

Give a fluid bo lus o f 500 ml o f crys tallo id

Yes
Do e s the patient have co mple x fluid o r Algo rithm 4: Re plac e me nt and Re dis tributio n
e le c tro lyte re plac e me nt o r abno rmal
Re as s e s s the patie nt us ing the ABCDE dis tributio n is s ue s ?
appro ac h (Airway, Bre athing , Circ ulatio n, Look for existing deficits or excesses, ongoing
Dis ability, Expo s ure ) losses, abnormal distribution or other complex
Are the re exis ting fluid Es timate de ficits o r exc e s s es and add to
Do e s the patient s till ne e d fluid issues. Yes
and/o r e le c trolyte de fic its o r o r s ubtrac t fro m no rmal daily
re s us c itatio n? exc e s s e s ? mainte nanc e re quireme nts
No
Check for:
dehydration
Yes No fluid overload Che c k fo r:
Alg o rithm 3: Ro utine Mainte nanc e hyper/hypokalaemia. vomiting and nasogastric tube loss
biliary drainage loss
Do e s the patient have
No
high/low volume ileal stoma loss
s ig ns o f s ho c k?
Give maintenanc e IV fluids diarrhoea/excess colostomy loss
Yes
Normal daily fluid and electrolyte requirements: Are the re any o ng o ing ongoing blood loss, e.g. melena
Yes No abno rmal fluid o r ele c tro lyte sweating/fever/dehydration
25–30 ml/kg/d water
lo s s e s ? pancreatic/jejunal fistula/stoma loss
1 mmol/kg/day sodium, potassium, chloride
urinary loss, e.g. post AKI polyuria.
50–100 g/day glucose (e.g. glucose 5% contains
5 g/100ml). No
>2000 ml Yes
given? S ee k e xpe rt he lp Prescribe for routine maintenance
urg e ntly Are the re o the r c o mple x
is s ue s ? requirement plus additional fluid and
Check if allowance required for: electrolyte supplements to replace the
No
Re as s e s s and mo nito r the patient gross oedema ‘measured’ abnormal ‘ongoing’ losses.
Give a furthe r fluid bo lus o f 250–500 ml o f Stop IV fluids when no longer needed. severe sepsis
Nasogastric fluids or enteral feeding are preferable hyper/hyponatraemia
c rys tallo id Monitor and reassess fluid and biochemical
when maintenance needs are more than 3 days. renal, liver and/or cardiac
impairment. status by clinical and laboratory monitoring.

Yes
S e e k e xpe rt help pro mptly