Four indications—four different prescriptions
- Resuscitation: restore perfusion in shock/hypovolaemia with an appropriate rapid fluid challenge, then reassess.
- Maintenance: provide daily water/electrolytes only when oral/enteral intake is inadequate.
- Replacement: replace measured or estimated abnormal losses (GI, drains, polyuria, burns) in addition to maintenance.
- De-resuscitation/restriction: stop or remove fluid when the patient is no longer fluid responsive and congestion is harmful.
Every bolus needs an endpoint
Prescribe fluid like a drug: type, dose, rate, indication, endpoint and stop rule. After a bolus, reassess perfusion, lungs/JVP, BP/MAP, capillary refill and urine output rather than ordering the next litre automatically.