FLUID CHALLENGE/FLUID RESUSCITATION CHART Reference: Algorithms for IV fluid therapy in adults NICE December 2013

1.Clinical examination
Assess volume status taking into
2.Trends and
account ,
3.Context.
Identify cause of deficit and respond.
Is the Patient Hypovolaemic and 1.SEPSIS 2. HYPOVOLEMIA 3.NOT SURE 4.____________
If Yes: Initiate treatment
needs fluid resuscitation? Give a fluid bolus of 500 ml of crystalloid (containing sodium in the range
of 130–154 mmol/l) over less than 15 minutes.
Choice of Fluid over less than 15
Date Start Time Finish
minutes.(4 or 5% Human Albumin Prescribed by Administered by Batch No.
Time
can be considered in Septic Shock)
1.HARTMANN’S OR
NORMAL SALINE 0.9% 500 ML
2.HARTMANN’S OR
NORMAL SALINE 0.9% 500 ML
3.HARTMANN’S OR
NORMAL SALINE 0.9% 500 ML
4.HARTMANN’S OR
NORMAL SALINE 0.9% 500 ML
If the patient still need fluid resuscitation? to maintain MAP >65-70 or
Systolic>100 mmHg
Reassess the patient using the
Seek expert help (ITU) if unsure about further management
ABCDE approach
If patient have signs of shock? Lactate >2 and Systolic BP<100 mmHg
If>2000 ml already given?
Remember:
1.Renal (Autoregulation range) MAP 70-170 mmHg, Hypertensives have a higher Autoregulation Range and they may require a Higher MAP (Driving
Pressure) to maintain Organ Blood flow and Oxygen Delivery.
2. The organs are interposed between the Left and Right side of the heart, If you give too much fluids it could congest the organs and decrease arterial flow
and oxygen delivery.
3.Fluid unresponsive Hypotension could also mean there is a Large Preload Deficit, Contractility, afterload or Heart Rate/Rhythm problems that needs
Critical care or Specialist Input.
4.A further Delay in Timely escalation to experts /Critical Care could cause significant End Organ Damage especially AKI.

drsamgeorge 2018