• The first question you should ask is “does your patient need intravenous fluids”?
• If so, do they need resuscitation fluids or maintenance fluids?
• Make sure you have taken a good history, performed a thorough exam and thought about your patients comorbidities and current clinical situation before prescribing fluids

• EUC’s and CMP:
• On the ward most patients do not need electrolytes checked more frequently than once a day
• If they have significant hypernatraemia or hyponatraemia they may need more frequent electrolyte monitoring and should have registrar or consultant input
• The small amounts of potassium in plasmalyte and Hartmanns are usually not an issue and rarely contribute to hyperkalaemia
  Does the hyperchloraemic metabolic acidosis caused by large volumes of 0.9%NaCl matter? The answer is no one is sure but may have different levels of significance in different patient populations. Elderly, very unwell and those with impaired kidney function may be more adversely affected by this

• What fluids can we give?
• Common Intravenous Fluids:
  • Crystalloids
    • Crystalloids that are more like Plasma (balanced salt solutions) vs Simple crystalloids
      • Simple crystalloid examples are 0.9% Sodium Chloride (Normal Saline) and 5% Dextrose
        • 150mmol NaCl in Normal Saline (higher than physiological concentrations)
        • Plasma like crystalloid examples are Hartmanns and Plasmalyte.
          • These have buffering and lower chloride and a bit more complicated in their composition
  • Colloids
    • Any fluid with large molecule suspended in it designed to promote the retention of that fluid in the intravascular space
    • Examples include Albumin, Gelofusin and Voluven2 (Hydroxyethyl Starch)
    • Use has not been proven to improve patient centred outcomes in the larger clinical trials and provide no benefit over the use of crystalloids1
• What fluids should we give in resuscitation:
  • Crystalloids: 0.9% Saline, Hartmanns, or plasmalyte can be used as resuscitation fluids
  • Usually prescribed as a 500ml to 1000ml Bolus
  • Sometimes Albumin (a colloid) can be used in specific patient populations but should be done with advice from a Registrar or Consultant
  • Patients should be reassessed after each bolus for response

• Does you patient need fluid?
• Do they need resuscitation or maintenance fluids or are they eating and drinking and can the fluids be ceased?
• Colloids are no better than crystalloids and should only be used with senior clinical input
• Customise the fluids you give especially in the more vulnerable patients
• Make sure you have taken a good history, performed a thorough exam and thought about your patients comorbidities and current clinical situation before prescribing fluids
• Evaluate the response after you have given the fluids you prescribed

Note this podcast pertains to the adult patient and should not be used as a guide in paediatric patients.