Indications a patient may require fluid resuscitation

• Systolic BP <100mmHg
• Heart rate >90bpm
• Capillary refill >2s
• Cool peripheries
• Respiratory rate >20bpm
• NEWS ≥5
• Dry mucous membranes
• A healthy kidney can excrete the body's waste in as little as 0.5ml/kg/hour - urine ouput less than this may indicate hypovolaemia
• Urea and creatinine can help guide fluid management - raised urea and creatinine can indicate dehydration or pre-renal failure due to hypovolaemia

Fluid resuscitation

• Identify cause of fluid deficit and respond appropriately
• Fluid bolus of 500mL crystalloid over <15 minutes
• Reassess using ABCDE approach
• Further fluid boluses (up to 2000mL) may be required

Maintenance fluids

• Assess ability to meet fluid needs enterally
• Assess fluid deficits, excess losses, abnormal fluid distribution
• Normal daily fluid requirements:
  • 25-30mL/kg/day water
  • 1mmol/kg/day sodium
  • 1mmol/kg/day potassium
  • 1mmol/kg/day chloride
  • 50–100g/day glucose to limit ketosis

IV fluids