CG174 Migrated

download CG174 Migrated

If you can't read please download the document

description

Guia clinica para terapia intravenosa 2013 en paciente hospitalizado

Transcript of CG174 Migrated

  • @FD @FD33HH7@AGERG;6F:7D7@AGERG;6F:7D3B3BK;@AK;@AHH7DE;@7DE;@:AEB;F3>:AEB;F3>

    >;@;53>9G;67>;@7

    G4>;E:76757?47D@;57AD9G=9G;63@5759

    !#"!"!%

    http://nice.org.uk/guidance/cg174
  • A@F7@FEA@F7@FE

    @FDA6G5F;A@

    3F;7@F57@FD7653D7

    " 7KBD;AD;F;7E8AD;?B>7?7@F3F;A@

    D;@5;B>7E3@6BDAFA5A>E8AD;@FD3H7@AGERG;6F:7D3BK

    EE7EE?7@F3@6?A@;FAD;@9

    )7EGE5;F3F;A@

    )AGF;@7?3;@F7@3@57

    +D3;@;@93@676G53F;A@

    )75A??7@63F;A@E

    +7D?EGE76;@F:;E9G;67>;@7

    D;@5;B>7E3@6BDAFA5A>E8AD;@FD3H7@AGERG;6F:7D3BK

    EE7EE?7@F3@6?A@;FAD;@9

    )7EGE5;F3F;A@

    )AGF;@7?3;@F7@3@57

    )7B>357?7@F3@6D76;EFD;4GF;A@

    + D3;@;@93@676G53F;A@

    )7E73D5:D75A??7@63F;A@E

    EE7EE?7@F3@6?A@;FAD;@9

    -RG;6F:7D3BK8ADRG;6D7EGE5;F3F;A@

    -RG;6F:7D3BK8ADRG;6D7EGE5;F3F;A@

    -RG;6F:7D3BK8ADDAGF;@7?3;@F7@3@57

    + D3;@;@93@676G53F;A@

    &F:7D;@8AD?3F;A@

    *5AB73@6:AIF:;E9G;67>;@7I3E67H7>AB76

    )7>3F76% 9G;63@57

    +:7G;67>;@77 H7>AB?7@FDAGB%3F;A@3>A>>34AD3F;@97@FD73@6% BDA;@77 H7>AB?7@FDAGB

    #! %$"($#! &$#"" #

    !#"!"!%

  • JB7DF36H;E7DEFAF:79DAGB

    %3F;A@3>>;@;53>G;67>;@77@FD7

    % BDA;@7

    *FD7@9F:A8D75A??7@63F;A@E

    &F:7DH7DE;A@EA8F:;E9G;67>;@7

    ?B>7?7@F3F;A@

    0AGDD7EBA@E;4;>;FK

    AB KD;9:F

    #! %$"($#! &$#"" #

    !#"!"!%

  • +:;E9G;67>;@7;EF:743E;EA8(*

    @FDA6G5F;A@ @FDA6G5F;A@

    +:;E9G;67>;@75A@F3;@ED75A??7@63F;A@E34AGF97@7D3>BD;@5;B>7E8AD?3@39;@9;@FD3H7@AGE

    -RG;6E3@63BB>;7EFA3D3@97A85A@6;F;A@E3@66;887D7@FE7FF;@9E F6A7E@AF;@5>G67

    D75A??7@63F;A@ED7>3F;@9FAEB75;Q55A@6;F;A@E

    $3@K36G>F:AEB;F3>;@B3F;7@FE@776;@FD3H7@AGE -RG;6F:7D3BKFABD7H7@FAD5ADD75FBDA4>7?E

    I;F:F:7;DRG;63@6AD7>75FDA>KF7EF3FGE75;6;@9A@F:7ABF;?3>3?AG@F3@65A?BAE;F;A@A8 -

    RG;6EFA4736?;@;EF7D763@6F:747EFD3F73FI:;5:FA9;H7F:7?53@4736;8Q5G>F3@65A?B>7JF3E=

    3@6675;E;A@E?GEF4743E76A@53D78G>3EE7EE?7@FA8F:7B3F;7@FE;@6;H;6G3>@776E

    DDADE;@BD7E5D;4;@9 -RG;6E3@67>75FDA>KF7E3D7B3DF;5G>3D>K>;=7>K;@7?7D97@5K67B3DF?7@FE

    35GF736?;EE;A@G@;FE3@697@7D3>?76;53>3@6EGD9;53>I3D6ED3F:7DF:3@;@AB7D3F;@9F:73FD7E3@6

    5D;F;53>53D7G@;FE*GDH7KE:3H7E:AI@F:3F?3@KEF388I:ABD7E5D;47 -RG;6E=@AI@7;F:7DF:7

    >;=7>KRG;63@67>75FDA>KF7@776EA8;@6;H;6G3>B3F;7@FE@ADF:7EB75;Q55A?BAE;F;A@A8F:7?3@K

    5:A;57EA8 -RG;6E3H3;>34>7FAF:7?*F3@63D6EA8D75AD6;@93@6?A@;FAD;@9 -RG;63@6

    7>75FDA>KF7F:7D3BK?3K3>EA47BAAD;@F:7E7E7FF;@9E -RG;6?3@397?7@F;@:AEB;F3>;EA8F7@

    67>793F76FAF:7?AEFEF388I:A8D7CG7@F>K>35=F:7D7>7H3@F7JB7D;7@573@6?3K

    :3 H7D757;H76>;FF>7AD@AEB75;Q5FD3;@;@9A@F:7EG4A@Q67@F;3>@CG;DK;@FA7D;AB7D3F;H773F:ED7BADF;@:;9:>;9:F76F:3F3

    E;9@;Q53@F@G?47DA8:AEB;F3>;E76B3F;7@FEI7D76K;@93E3D7EG>FA8;@8GE;A@A8FAA?G5:ADFAA

    >;FF>7RG;6+:7D7BADFD75A??7@676F:3FRG;6BD7E5D;4;@9E:AG>6479;H7@F:7E3?7EF3FGE3E6DG9

    BD7E5D;4;@9>F:AG9:?;E?3@397?7@FA8RG;6F:7D3BK;ED3D7>KD7BADF763E47;@9D7EBA@E;4>78AD

    B3F;7@F:3D?;F;E>;=7>KF:3F3E?3@K3E;@B3F;7@FEA@ -RG;6E3@67>75FDA>KF7EEG887D

    5A?B>;53F;A@EAD?AD4;6;FK6G7FAF:7;D;@3BBDABD;3F736?;@;EFD3F;A@

    +:7D7;E3>EA5A@E;67D34>76743F734AGFF:747EF -RG;6EFAGE7B3DF;5G>3D>K8AD?AD7E7D;AGE>K;>>

    AD;@F;@9;@I;67H3D;3F;A@;@5>;@;53>BD35F;57$3@KD73EA@EG@67D>;7F:7

    A@9A;@96743F74GF?AEFD7HA>H73DAG@66;8Q5G>F;7E;@;@F7DBD7F3F;A@A84AF:FD;3>7H;67@573@6

    5>;@;53>7JB7D;7@57;@5>G6;@9F:78A>>AI;@9835FADE

    $3@K3557BF76BD35F;57EA8 -RG;6BD7E5D;4;@9I7D767H7>AB768AD:;EFAD;53>D73EA@ED3F:7D

    F:3@F:DAG9:5>;@;53>FD;3>E

    #! %$"($#! &$#"" #

    !#"!"!%

  • +D;3>E53@@AF73E;>K47;@5>G676;@?7F33@3>KE7E4753GE7F:7K7J3?;@7H3D;76AGF5A?7

    ?73EGD7E;@:7F7DA97@7AGE9DAGBE5A?B3D;@9@AFA@>K6;887D7@FFKB7EA8RG;6I;F:6;887D7@F

    7>75FDA>KF75A@F7@F4GF3>EA6;887D7@FHA>G?7E3@6D3F7EA836?;@;EFD3F;A@3@6;@EA?753E7E

    F:7366;F;A@3>GE7A8;@AFDAB7EADH3EABD7EEADE

    $AEFFD;3>E:3H7477@G@67DF3=7@;@AB7D3F;@9F:73FD7E3@65D;F;53>53D7G@;FED3F:7DF:3@

    36?;EE;A@G@;FEAD97@7D3>3@67>67D>K53D7E7FF;@9E

    +D;3>E5>3;?;@9FA7J3?;@747EF73D>KF:7D3BK8ADRG;6D7EGE5;F3F;A@:3H735FG3>>K7H3>G3F76

    F:7D3BK5:A;57E?36738F7D;@;F;3>RG;6D7EGE5;F3F;A@I;F:B3F;7@FE3>D736K;@5D;F;53>53D7AD

    AB7D3F;@9F:73FD7E

    $3@KFD;3>E;@87DD;@947EFF:7D3BK8ADRG;6D7EGE5;F3F;A@38F7D35GF7RG;6>AEE:3H735FG3>>K

    7J3?;@76E;FG3F;A@EA8:KBAHA>37?;3;@6G5764K3@37EF:7E;3

    +:7D7;E35>73D@7768AD9G;63@57A@ -RG;6F:7D3BK8AD97@7D3>3D73EA8:AEB;F3>BD35F;575AH7D;@9

    4AF:F:7BD7E5D;BF;A@3@6?A@;FAD;@9A8 -RG;63@67>75FDA>KF7F:7D3BK3@6F:7FD3;@;@93@6

    76G53F;A@3>@776EA83>>:AEB;F3>EF388;@HA>H76;@ -RG;6?3@397?7@F

    +:73;?A8F:;E% 9G;67>;@7;EFA:7>BBD7E5D;47DEG@67DEF3@6F:7

    B: KE;A>A9;53>BD;@5;B>7EF:3FG@67DB;@RG;6BD7E5D;4;@9

    B3F:AB:KE;A>A9;53>5:3@97EF:3F38875FRG;643>3@57;@6;E73E7EF3F7E

    ;@6;53F;A@E8AD -RG;6F:7D3BK

    D73EA@E8ADF:75:A;57A8F:7H3D;AGERG;6E3H3;>34>73@63@6

    BD;@5;B>7EA83EE7EE;@9RG;643>3@57

    @67H7>AB;@9F:79G;67>;@7;FI3E@757EE3DKFA>;?;FF:7E5AB74K7J5>G6;@9B3F;7@F9DAGBEI;F:

    ?AD7EB75;3>;E76RG;6BD7E5D;4;@9@776E F;E;?BADF3@FFA7?B:3E;E7F:3FF:7D75A??7@63F;A@E6A

    @AF3BB>KFAB3F;7@FEG@67DK73DEBD79@3@FIA?7@3@6F:AE7I;F:E7H7D7>;H7DADD7@3>6;E73E7

    6;347F7EAD4GD@E+:7K3>EA6A@AF3BB>KFAB3F;7@FE@776;@9;@AFDAB7E3@6F:AE7A@;@F7@E;H7

    ?A@;FAD;@93@6EAF:7K:3H7>7EED7>7H3@57FA;@F7@E;H753D7E7FF;@9E3@6B3F;7@FE6GD;@9EGD9;53>

    3@37EF:7E;33F;7@FEI;F:FD3G?3F;54D3;@;@G6;@9B3F;7@FE@776;@9@7GDAEGD97DK3D73>EA

    7J5>G676+:7E5AB7A8F:79G;67>;@76A7E@AF5AH7DF:7BD35F;53>3EB75FEA836?;@;EFD3F;A@3E

    ABBAE76FAF:7BD7E5D;BF;A@A8 -RG;6E

    #! %$"($#! &$#"" #

    !#"!"!%

  • F;E:AB76F:3FF:;E9G;67>;@7I;>>>736FA47FF7DRG;6BD7E5D;4;@9;@:AEB;F3>;E76B3F;7@FED76G57

    ?AD4;6;FK3@6?ADF3>;FK3@6>736FA47FF7DB3F;7@FAGF5A?7E

    *FD3F79;7E8AD8GDF:7DD7E73D5:;@FAF:7EG4EA477@BDABAE76

    +:79G;67>;@7I;>>3EEG?7F:3FBD7E5D;47DEI;>>GE736DG9EEG??3DKA8BDA6G5F5:3D35F7D;EF;5EFA

    ;@8AD?675;E;A@E?367I;F:;@6;H;6G3>B3F;7@FE

    #! %$"($#! &$#"" #

    !#"!"!%

  • 3F;7@F57@FD7653D73F;7@F57@FD7653D7

    +:;E9G;67>;@7A887DE47EFBD35F;5736H;57A@F:753D7A8B7AB>7AH7D K73DEI:A3D7;@:AEB;F3>

    D757;H;@9;@FD3H7@AGERG;6F:7D3BK

    3F;7@FE3@6:73>F:53D7BDA87EE;A@3>E:3H7D;9:FE3@6D7EBA@E;4;>;F;7E3EE7FAGF;@F:7%*

    A@EF;FGF;A@8AD@9>3@6O3>>% 9G;63@57;EID;FF7@FAD7R75FF:7E7+D73F?7@F3@653D7E:AG>6

    F3=7;@FA355AG@F;@6;H;6G3>@776E3@6BD787D7@57E3F;7@FEE:AG>6:3H7F:7ABBADFG@;FKFA?3=7

    ;@8AD?76675;E;A@E34AGFF:7;D53D73@6FD73F?7@F;@B3DF@7DE:;BI;F:F:7;D:73>F:53D7

    BDA87EE;A@3>E73>F:53D7BDA87EE;A@3>EE:AG>68A>>AIF:77B3DF?7@FA873>F:E36H;57A@

    5A@E7@F 8EA?7A@76A7E@AF:3H753B35;FKFA?3=7675;E;A@E:73>F:53D7BDA87EE;A@3>EE:AG>6

    8A>>AIF:75A67A8BD35F;57F:3F355A?B3@;7EF:7$7@F3>3B35;FK5F3@6F:7EGBB>7?7@F3DK5A67

    A8BD35F;57A@67BD;H3F;A@A8>;47DFKE3879G3D6E @.3>7E:73>F:53D7BDA87EE;A@3>EE:AG>68A>>AI

    36H;57A@5A@E7@F8DA?F:7.7>E:AH7D@?7@F

    % :3EBDA6G5769G;63@57A@F:75A?BA@7@FEA89AA6B3F;7@F7JB7D;7@57;@36G>F%*E7DH;57E

    >>:73>F:53D7BDA87EE;A@3>EE:AG>68A>>AIF:7D75A??7@63F;A@E;@ 3F;7@F7JB7D;7@57;@36G>F%*

    E7DH;57E

    #! %$"($#! &$#"" #

    !#"!"!%

    https://www.gov.uk/government/publications/the-nhs-constitution-for-englandhttps://www.gov.uk/government/publications/the-nhs-constitution-for-englandhttps://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-editionhttps://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-editionhttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085476http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085476http://www.wales.nhs.uk/consenthttp://www.nice.org.uk/guidance/cg138http://www.nice.org.uk/guidance/cg138
  • "" 77KBD;AD;F;7E8AD;?B>7?7@F3F;A@KBD;AD;F;7E8AD;?B>7?7@F3F;A@

    +:78A>>AI;@9D75A??7@63F;A@E:3H7477@;67@F;Q763EBD;AD;F;7E8AD;?B>7?7@F3F;A@+:78G>>>;EF

    A8D75A??7@63F;A@E;E;@E75F;A@

    )"&"($*&() +$*)"&+) - &,*2,"+!) (0

    .:7@BD7E5D;4;@9 -RG;6ED7?7?47DF:7)E)7EGE5;F3F;A@)AGF;@7?3;@F7@3@57

    )7B>357?7@F)76;EFD;4GF;A@3@6)73EE7EE?7@F

    &887D -RG;6F:7D3BK3EB3DFA83BDAFA5A>E77>9AD;F:?E8AD -RG;6F:7D3BK

    EE7EEB3F;7@FERG;63@67>75FDA>KF7@776E8A>>AI;@9>9AD;F:? EE7EE?7@F

    8B3F;7@FE@776 -RG;6E8ADRG;6D7EGE5;F3F;A@8A>>AI>9AD;F:? >G;6D7EGE5;F3F;A@

    8B3F;7@FE@776 -RG;6E8ADDAGF;@7?3;@F7@3@578A>>AI>9AD;F:? )AGF;@7

    ?3;@F7@3@57

    8B3F;7@FE@776 -RG;6EFA366D7EE7J;EF;@967Q5;FEAD7J57EE7EA@9A;@934@AD?3>

    >AEE7EAD34@AD?3>RG;66;EFD;4GF;A@8A>>AI>9AD;F:? )7B>357?7@F3@6

    D76;EFD;4GF;A@

    3F;7@FEE:AG>6:3H73@ -RG;6?3@397?7@FB>3@I:;5:E:AG>6;@5>G6767F3;>EA8

    F:7RG;63@67>75FDA>KF7BD7E5D;BF;A@AH7DF:7@7JF :AGDE

    F:73EE7EE?7@F3@6?A@;FAD;@9B>3@

    @;F;3>>KF:7 -RG;6?3@397?7@FB>3@E:AG>647D7H;7I764K3@7JB7DF63;>K -RG;6

    ?3@397?7@FB>3@E8ADB3F;7@FEA@>A@97DF7D? -RG;6F:7D3BKI:AE75A@6;F;A@;E

    EF34>7?3K47D7H;7I76>7EE8D7CG7@F>K

    ****%&+&%&"+)"&

    EE7EEF:7B3F;7@FE>;=7>KRG;63@67>75FDA>KF7@776E8DA?F:7;D:;EFADK5>;@;53>7J3?;@3F;A@

    5GDD7@F?76;53F;A@E5>;@;53>?A@;FAD;@93@6>34AD3FADK;@H7EF;93F;A@E

    ;EFADKE:AG>6;@5>G673@KBD7H;AGE>;?;F76;@F3=7F:;DEFF:7CG3@F;FK3@65A?BAE;F;A@

    A834@AD?3>>AEE7EE77;39D3?A8A@9A;@9>AEE7E3@63@K5A?AD4;6;F;7E;@5>G6;@9

    B3F;7@FEI:A3D7?3>@AGD;E:763@63FD;E=A8D78776;@9EK@6DA?7E77%GFD;F;A@EGBBADF

    ;@36G>FE1% 5>;@;53>9G;67>;@72

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg32http://www.nice.org.uk/guidance/cg32
  • >;@;53>7J3?;@3F;A@E:AG>6;@5>G673@3EE7EE?7@FA8F:7B3F;7@FERG;6EF3FGE

    ;@5>G6;@9

    BG>E74>AA6BD7EEGD753B;>>3DKD7Q>>3@63DH7@AGEBD7EEGD7

    BD7E7@57A8BG>?A@3DKADB7D;B:7D3>A767?3

    BD7E7@57A8BAEFGD3>:KBAF7@E;A@

    >;@;53>?A@;FAD;@9E:AG>6;@5>G675GDD7@FEF3FGE3@6FD7@6E;@

    %3F;A@3>3D>K.3D@;@9*5AD7%.*

    RG;643>3@575:3DFE

    I7;9:F

    #34AD3FADK;@H7EF;93F;A@EE:AG>6;@5>G675GDD7@FEF3FGE3@6FD7@6E;@

    8G>>4>AA65AG@F

    GD735D73F;@;@73@67>75FDA>KF7E

    >>B3F;7@FE5A@F;@G;@9FAD757;H7 -RG;6E@776D79G>3D?A@;FAD;@9+:;EE:AG>6;@;F;3>>K;@5>G67

    3F>73EF63;>KD73EE7EE?7@FEA85>;@;53>RG;6EF3FGE>34AD3FADKH3>G7EGD735D73F;@;@73@6

    7>75FDA>KF7E3@6RG;643>3@575:3DFE3>A@9I;F:I7;9:F?73EGD7?7@FFI;57I77=>K73 I3D7

    F:3F

    3F;7@FED757;H;@9 -RG;6F:7D3BKFA366D7EED7B>357?7@FADD76;EFD;4GF;A@BDA4>7?E

    ?3 K@776?AD78D7CG7@F?A@;FAD;@9

    66;F;A@3>?A@;FAD;@9A8GD;@3DKEA6;G??3K47:7>B8G>;@B3F;7@FEI;F::;9:HA>G?7

    93EFDA;@F7EF;@3>>AEE7E)76G576GD;@3DKEA6;G?7J5D7F;A@1>7EEF:3@??A>>2?3K

    ;@6;53F7FAF3>4A6KEA6;G?67B>7F;A@7H7@;8B>3E?3EA6;G?>7H7>E3D7@AD?3>,D;@3DK

    EA6;G??3K3>EA;@6;53F7F:753GE7A8:KBA@3FD37?;33@69G;67F:735:;7H7?7@FA83

    @793F;H7EA6;G?43>3@57;@B3F;7@FEI;F:A767?3AI7H7DGD;@3DKEA6;G?H3>G7E?3K

    47?;E>736;@9;@F:7BD7E7@57A8D7@3>;?B3;D?7@FAD6;GD7F;5F:7D3BK

    3F;7@FEA@>A@97DF7D? -RG;6F:7D3BKI:AE75A@6;F;A@;EEF34>7?3K47?A@;FAD76

    >7EE8D7CG7@F>K3>F:AG9:675;E;A@EFAD76G57?A@;FAD;@98D7CG7@5KE:AG>64767F3;>76;@

    F:7;D -RG;6?3@397?7@FB>3@

    #! %$"($#! &$#"" #

    !#"!"!%

  • >73D;@5;67@FEA8RG;6?;E?3@397?7@F8AD7J3?B>7G@@757EE3D;>KBDA>A@97667:K6D3F;A@AD

    ;@36H7DF7@FRG;6AH7D>A366G7FA -RG;6F:7D3BKE:AG>647D7BADF76F:DAG9:EF3@63D65D;F;53>

    ;@5;67@FD7BADF;@9FA7@5AGD397;?BDAH76FD3;@;@93@6BD35F;57E77A@E7CG7@57EA8RG;6

    ?;E?3@397?7@FFA47D7BADF763E5D;F;53>;@5;67@FE

    *,*"++"&

    8B3F;7@FE@776 -RG;6D7EGE5;F3F;A@GE75DKEF3>>A;6EF:3F5A@F3;@EA6;G?;@F:7D3@97

    O ??A>>I;F:34A>GEA8?>AH7D>7EEF:3@?;@GF7EAD?AD7;@8AD?3F;A@E77

    F:7 A?BAE;F;A@A85A??A@>KGE765DKEF3>>A;6EF34>7

    ,+"&%"&+&&

    8B3F;7@FE@776 -RG;6E8ADDAGF;@7?3;@F7@3@573>A@7D7EFD;5FF:7;@;F;3>BD7E5D;BF;A@FA

    O ?>=963KA8I3F7D3@63@6

    3BBDAJ;?3F7>K??A>=963 KA8BAF3EE;G?EA6;G?3@65:>AD;673@63@6

    3BBDAJ;?3F7>KO 963KA89>G5AE7FA>;?;FEF3DH3F;A@=7FAE;E+:;ECG3@F;FKI;>>

    @AF366D7EEB3F;7@FE@GFD;F;A@3>@776EE77%GFD;F;A@EGBBADF;@36G>FE1% 5>;@;53>

    9G;67>;@72

    AD?AD7;@8AD?3F;A@E77 -RG;6BD7E5D;BF;A@8ADDAGF;@7?3;@F7@3@57AH7D3:AGDB7D;A6

    )"&"& &,+"&

    AEB;F3>EE:AG>67EF34>;E:EKEF7?EFA7@EGD7F:3F3>>:73>F:53D7BDA87EE;A@3>E;@HA>H76;@

    BD7E5D;4;@93@667>;H7D;@9 -RG;6F:7D3BK3D7FD3;@76A@F:7BD;@5;B>7E5AH7D76;@F:;E

    9G;67>;@73@63D7F:7@8AD?3>>K3EE7EE763@6D73EE7EE763FD79G>3D;@F7DH3>EFA67?A@EFD3F7

    5A?B7F7@57;@

    G@67DEF3@6;@9F:7B:KE;A>A9KA8RG;63@67>75FDA>KF743>3@57;@B3F;7@FEI;F:@AD?3>

    B: KE;A>A9K3@66GD;@9;>>@7EE

    3EE7EE;@9B3F;7@FERG;63@67>75FDA>KF7@776EF:7)E)7EGE5;F3F;A@)AGF;@7

    ?3;@F7@3@57)7B>357?7@F)76;EFD;4GF;A@3@6)73EE7EE?7@F

    3EE7EE;@9F:7D;E=E47@7QFE3@6:3D?EA8 -RG;6E

    BD7E5D;4;@93@636?;@;EF7D;@9 -RG;6E

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174/resources/cg174-intravenous-fluid-therapy-in-adults-in-hospital-composition-of-commonly-used-crystalloids-table-2http://www.nice.org.uk/guidance/cg32
  • ?A@;FAD;@9F:7B3F;7@FD7EBA@E7

    7H3>G3F;@93@66A5G?7@F;@95:3@97E3@63@6

    F3=;@93BBDABD;3F735F;A@3ED7CG;D76

    AEB;F3>EE:AG>6:3H73@ -RG;6E>736D7EBA@E;4>78ADFD3;@;@95>;@;53>9AH7D@3@573G6;F3@6

    D7H;7IA8 -RG;6BD7E5D;4;@93@6B3F;7@FAGF5A?7E

    #! %$"($#! &$#"" #

    !#"!"!%

  • )75A??7@63F;A@E)75A??7@63F;A@E

    +:78A>>AI;@99G;63@57;E43E76A@F:747EF3H3;>34>77H;67@57+:78G>>9G;67>;@79;H7E67F3;>EA8

    F:7?7F:A6E3@6F:77H;67@57GE76FA67H7>ABF:79G;63@57

    )%*,*"&+!"* ,"$"&

    @F:;E9G;67>;@7F:7F7D?7JB7DFD787DEFA3:73>F:53D7BDA87EE;A@3>I:A:3E5AD75A?B7F7@5;7EFA

    6;39@AE73@6?3@39735GF7;>>@7EE+:7E75A?B7F7@5;7E53@4767>;H7D764K3H3D;7FKA8?A67>E3F3

    >A53>>7H7>EG5:3E35D;F;53>53D7AGFD735:F73?3:AEB;F3>3F@;9:FF73?AD3EB75;3>;EFFD3;@77;@3@

    35GF7?76;53>ADEGD9;53>EB75;3>FK AD?AD7;@8AD?3F;A@E775GF7>K;>>B3F;7@FE;@:AEB;F3>%

    5>;@;53>9G;67>;@7

    +:7IAD6;@9GE76;@F:7D75A??7@63F;A@E;@F:;E9G;67>;@78AD7J3?B>7IAD6EEG5:3EA887D

    3@65A@E;67D67@AF7EF:757DF3;@FKI;F:I:;5:F:7D75A??7@63F;A@;E?367F:7EFD7@9F:A8

    F:7D75A??7@63F;A@*774AGFF:;E9G;67>;@78AD67F3;>E

    )"&"($*&() +$*)"&+) - &,*2,"+!) (0

    +:73EE7EE?7@F3@6?3@397?7@FA8B3F;7@FERG;63@67>75FDA>KF7@776E;E8G@63?7@F3>FA9AA6

    B3F;7@F53D7

    EE7EE3@6?3@397B3F;7@FERG;63@67>75FDA>KF7@776E3EB3DFA87H7DKI3D6

    D7H;7I DAH;67;@FD3H7@AGE -RG;6F:7D3BKA@>K8ADB3F;7@FEI:AE7@776E

    53@@AF47?7F4KAD3>AD7@F7D3>DAGF7E3@6EFAB3EEAA@3EBAEE;4>7

    *=;>>763@65A?B7F7@F:73>F:53D7BDA87EE;A@3>EE:AG>6BD7E5D;473@636?;@;EF7D

    -RG;6E3@63EE7EE3@6?A@;FADB3F;7@FED757;H;@9 -RG;6EE77

    D75A??7@63F;A@EO

    .:7@BD7E5D;4;@9 -RG;6ED7?7?47DF:7)E)7EGE5;F3F;A@)AGF;@7

    ?3;@F7@3@57)7B>357?7@F)76;EFD;4GF;A@3@6)73EE7EE?7@F

    &887D -RG;6F:7D3BK3EB3DFA83BDAFA5A>E77>9AD;F:?E8AD -RG;6F:7D3BK

    EE7EEB3F;7@FERG;63@67>75FDA>KF7@776E8A>>AI;@9>9AD;F:? EE7EE?7@F

    8B3F;7@FE@776 -RG;6E8ADRG;6D7EGE5;F3F;A@8A>>AI>9AD;F:? >G;6D7EGE5;F3F;A@

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174/evidencehttp://www.nice.org.uk/guidance/cg50http://www.nice.org.uk/guidance/cg174/chapter/about-this-guideline
  • 8B3F;7@FE@776 -RG;6E8ADDAGF;@7?3;@F7@3@578A>>AI>9AD;F:? )AGF;@7

    ?3;@F7@3@57

    8B3F;7@FE@776 -RG;6EFA366D7EE7J;EF;@967Q5;FEAD7J57EE7EA@9A;@934@AD?3>

    >AEE7EAD34@AD?3>RG;66;EFD;4GF;A@8A>>AI>9AD;F:? )7B>357?7@F3@6

    D76;EFD;4GF;A@

    >9AD;F:?E8AD -RG;6F:7D>9AD;F:?E8AD -RG;6F:7D3B3BKK

    AI@>A36F:7 :7D7

    @5>G67F:78A>>AI;@9;@8AD?3F;A@;@ -RG;6BD7E5D;BF;A@E

    +:7FKB7A8RG;6FA4736?;@;EF7D76

    +:7D3F73@6HA>G?7A8RG;6FA4736?;@;EF7D76

    3F;7@FEE:AG>6:3H73@ -RG;6?3@397?7@FB>3@I:;5:E:AG>6;@5>G6767F3;>E

    A8

    F:7RG;63@67>75FDA>KF7BD7E5D;BF;A@AH7DF:7@7JF :AGDE

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/proxy/?sourceUrl=http%3a%2f%2fguidance.nice.org.uk%2fCG174%2fAlgorithmPoster
  • F:73EE7EE?7@F3@6?A@;FAD;@9B>3@

    @;F;3>>KF:7 -RG;6?3@397?7@FB>3@E:AG>647D7H;7I764K3@7JB7DF63;>K -RG;6

    ?3@397?7@FB>3@E8ADB3F;7@FEA@>A@97DF7D? -RG;6F:7D3BKI:AE75A@6;F;A@;E

    EF34>7?3K47D7H;7I76>7EE8D7CG7@F>K

    .:7@BD7E5D;4;@9 -RG;6E3@67>75FDA>KF7EF3=7;@FA355AG@F3>>AF:7DEAGD57E

    A8RG;63@67>75FDA>KF7;@F3=7;@5>G6;@93@KAD3>AD7@F7D3>;@F3=73@6;@F3=7

    8DA?6DG9E -@GFD;F;A@4>AA63@64>AA6BDA6G5FE

    3F;7@FE:3H73H3>G34>75A@FD;4GF;A@FA?3=7FAF:7;DRG;643>3@57 83B3F;7@F

    @776E -RG;6E7JB>3;@F:7675;E;A@3@66;E5GEEF:7E;9@E3@6EK?BFA?EF:7K

    @776FA>AA=AGF8AD;8F:7;DRG;643>3@57@776E367ADI:7@

    3E=76BDAH;67ID;FF7@;@8AD?3F;A@8AD7J3?B>7% E @8AD?3F;A@8ADF:7

    BG4>;53@6;@HA>H7F:7B3F;7@FE83?;>K?7?47DEAD53D7DE3E3BBDABD;3F7

    ****%&+&%&"+)"&

    @;F;3>3EE7EE?7@F @;F;3>3EE7EE?7@F

    EE7EEI:7F:7DF:7B3F;7@F;E:KBAHA>37?;5 @6;53FADEF:3F3B3F;7@F?3K@776

    GD97@FRG;6D7EGE5;F3F;A@;@5>G67

    EKEFA>;54>AA6BD7EEGD7;E>7EEF:3@??9

    :73DFD3F7;E?AD7F:3@473FEB7D?;@GF7

    53B;>>3DKD7Q>>F;?7;E?AD7F:3@E75A@6EADB7D;B:7D;7E3D75A>6FAFAG5:

    D7EB;D3FADKD3F7;E?AD7F:3@4D73F:EB7D?;@GF7

    %3F;A@3>3D>K.3D@;@9*5AD7%.*;EAD?AD7

    B3EE;H7>79D3;E;@9EG997EFERG;6D7EBA@E;H7@7EE1 2

    EE7EEF:7B3F;7@FE>;=7>KRG;63@67>75FDA>KF7@776E8DA?F:7;D:;EFADK5>;@;53>

    7J3?;@3F;A@5GDD7@F?76;53F;A@E5>;@;53>?A@;FAD;@93@6>34AD3FADK

    ;@H7EF;93F;A@E

    ;EFADKE:AG>6;@5>G673@KBD7H;AGE>;?;F76;@F3=7F:;DEFF:7CG3@F;FK3@6

    5A?BAE;F;A@A834@AD?3>>AEE7EE77;39D3?A8A@9A;@9>AEE7E3@63@K

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174http://www.nice.org.uk/guidance/cg174
  • 5A?AD4;6;F;7E;@5>G6;@9B3F;7@FEI:A3D7?3>@AGD;E:763@63FD;E=A8D78776;@9

    EK@6DA?7E77%GFD;F;A@EGBBADF;@36G>FE1% 5>;@;53>9G;67>;@72

    >;@;53>7J3?;@3F;A@E:AG>6;@5>G673@3EE7EE?7@FA8F:7B3F;7@FERG;6EF3FGE

    ;@5>G6;@9

    BG>E74>AA6BD7EEGD753B;>>3DKD7Q>>3@63DH7@AGEBD7EEGD7

    BD7E7@57A8BG>?A@3DKADB7D;B:7D3>A767?3

    BD7E7@57A8BAEFGD3>:KBAF7@E;A@

    >;@;53>?A@;FAD;@9E:AG>6;@5>G675GDD7@FEF3FGE3@6FD7@6E;@

    %.*

    RG;643>3@575:3DFE

    I7;9:F

    #34AD3FADK;@H7EF;93F;A@EE:AG>6;@5>G675GDD7@FEF3FGE3@6FD7@6E;@

    8G>>4>AA65AG@F

    GD735D73F;@;@73@67>75FDA>KF7E

    )73EE7EE?7@F)73EE7EE?7@F

    8B3F;7@FE3D7D757;H;@9 -RG;6E8ADD7EGE5;F3F;A@D73EE7EEF:7B3F;7@FGE;@9F:7

    3BBDA35:;DI3 KD73F:;@9;D5G>3F;A@;E34;>;FKJBAEGD7?A@;FAD

    F:7;DD7EB;D3FADKD3F7BG>E74>AA6BD7EEGD73@6B7D8GE;A@5A@F;@GAGE>K3@6

    ?73EGD7F:7;DH7@AGE>35F3F7>7H7>E3@6AD3DF7D;3>B3@643E77J57EE

    355AD6;@9FA9G;63@57A@36H3@576>;87EGBBADF)7EGE5;F3F;A@AG@5;>1,"2

    >>B3F;7@FE5A@F;@G;@9FAD757;H7 -RG;6E@776D79G>3D?A@;FAD;@9+:;EE:AG>6

    ;@;F;3>>K;@5>G673F>73EF63;>KD73EE7EE?7@FEA85>;@;53>RG;6EF3FGE>34AD3FADK

    H3>G7EGD735D73F;@;@73@67>75FDA>KF7E3@6RG;643>3@575:3DFE3>A@9I;F:

    I7;9:F?73EGD7?7@FFI;57I77=>K73 I3D7F:3F

    3F;7@FED757;H;@9 -RG;6F:7D3BKFA366D7EED7B>357?7@FADD76;EFD;4GF;A@BDA4>7?E

    ?3 K@776?AD78D7CG7@F?A@;FAD;@9

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg32
  • 66;F;A@3>?A@;FAD;@9A8GD;@3DKEA6;G??3K47:7>B8G>;@B3F;7@FEI;F::;9:HA>G?7

    93EFDA;@F7EF;@3>>AEE7E)76G576GD;@3DKEA6;G?7J5D7F;A@1>7EEF:3@??A>>2?3K

    ;@6;53F7FAF3>4A6KEA6;G?67B>7F;A@7H7@;8B>3E?3EA6;G?>7H7>E3D7@AD?3>,D;@3DK

    EA6;G??3K3>EA;@6;53F7F:753GE7A8:KBA@3FD37?;33@69G;67F:735:;7H7?7@FA83

    @793F;H7EA6;G?43>3@57;@B3F;7@FEI;F:A767?3AI7H7DGD;@3DKEA6;G?H3>G7E

    ?3 K47?;E>736;@9;@F:7BD7E7@57A8D7@3>;?B3;D?7@FAD6;GD7F;5F:7D3BK

    3F;7@FEA@>A@97DF7D? -RG;6F:7D3BKI:AE75A@6;F;A@;EEF34>7?3K47?A@;FAD76

    >7EE8D7CG7@F>K3>F:AG9:675;E;A@EFAD76G57?A@;FAD;@98D7CG7@5KE:AG>64767F3;>76

    ;@F:7;D -RG;6?3@397?7@FB>3@

    8B3F;7@FE:3H7D757;H76 -RG;6E5A@F3;@;@95:>AD;675A@57@FD3F;A@E9D73F7D

    F:3@ ??A>>8AD7J3?B>7EA6;G?5:>AD;67?A@;FADF:7;DE7DG?

    5:>AD;675A@57@FD3F;A@63;>K 8B3F;7@FE67H7>AB:KB7D5:>AD37?;3AD35;637?;3

    D73EE7EEF:7;D -RG;6BD7E5D;BF;A@3@63EE7EEF:7;D35;6O43E7EF3FGEA@E;67D

    >7EE8D7CG7@F?A@;FAD;@98ADB3F;7@FEI:A3D7EF34>7

    >73D;@5;67@FEA8RG;6?;E?3@397?7@F8AD7J3?B>7G@@757EE3D;>KBDA>A@976

    67: K6D3F;A@AD;@36H7DF7@FRG;6AH7D>A366G7FA -RG;6F:7D3BKE:AG>647

    D7BADF76F:DAG9:EF3@63D65D;F;53>;@5;67@FD7BADF;@9FA7@5AGD397;?BDAH76

    FD3;@;@93@6BD35F;57E77A@E7CG7@57EA8RG;6?;E?3@397?7@FFA47D7BADF76

    3E5D;F;53>;@5;67@FE

    8B3F;7@FE3D7FD3@E87DD76FA36;887D7@F>A53F;A@D73EE7EEF:7;DRG;6EF3FGE3@6

    -RG;6?3@397?7@FB>3@A@3DD;H3>;@F:7@7IE7FF;@9

    *,*"++"&

    8B3F;7@FE@776 -RG;6D7EGE5;F3F;A@GE75DKEF3>>A;6EF:3F5A@F3;@EA6;G?;@F:7

    D3@97O ??A>>I;F:34A>GEA8?>AH7D>7EEF:3@?;@GF7EAD

    ?AD7;@8AD?3F;A@E77F:7A?BAE;F;A@A85A??A@>KGE765DKEF3>>A;6EF34>7

    A@AFGE7F7FD3EF3D5:8ADRG;6D7EGE5;F3F;A@

    A@E;67D:G?3@3>4G?;@EA>GF;A@O8ADRG;6D7EGE5;F3F;A@A@>K;@B3F;7@FE

    I;F:E7 H7D7E7BE;E

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174/resources/cg174-intravenous-fluid-therapy-in-adults-in-hospital-composition-of-commonly-used-crystalloids-table-2
  • ,+"&%"&+&&

    8B3F;7@FE@776 -RG;6E8ADDAGF;@7?3;@F7@3@573>A@7D7EFD;5FF:7;@;F;3>

    BD7E5D;BF;A@FA

    O ?>=963KA8I3F7D3@63@6

    3BBDAJ;?3F7>K??A>=963 KA8BAF3EE;G?EA6;G?3@65:>AD;673@63@6

    3BBDAJ;?3F7>KO 963KA89>G5AE7FA>;?;FEF3DH3F;A@=7FAE;E+:;ECG3@F;FKI;>>

    @AF366D7EEB3F;7@FE@GFD;F;A@3>@776EE77%GFD;F;A@EGBBADF;@36G>FE1% 5>;@;53>

    9G;67>;@72

    AD?AD7;@8AD?3F;A@E77 -RG;6BD7E5D;BF;A@8ADDAGF;@7?3;@F7@3@57AH7D3:AGD

    B7D;A6

    ADB3F;7@FEI:A3D7A47E7364A6K

    I7;9:F,E7>AI7DD3@97HA>G?7EB7D=9B3F;7@FED3D7>K@776?AD7F:3@3FAF3>

    A8>;FD7EA8RG;6B7D63K3@6E77=7JB7DF:7>B;8F:7;D$ ;E?AD7F:3@=9

    ?

    A@E;67DBD7E5D;4;@9>7EERG;68AD7J3?B>7O ?>=963KRG;68ADB3F;7@FE

    I:A

    3D7A>67DAD8D3;>

    :3 H7D7@3>;?B3;D?7@FAD53D6;3583;>GD7

    3D7?3>@AGD;E:763@63FD;E=A8D78776;@9EK@6DA?7E77%GFD;F;A@EGBBADF;@36G>FE

    1% 5>;@;53>9G;67>;@72

    .:7@BD7E5D;4;@98ADDAGF;@7?3;@F7@3@573>A@75A@E;67DGE;@9O?>=9

    63KEA6;G?5:>AD;67;@9>G5AE7I;F: ??A>>BAF3EE;G?A@63K

    F:7D73D7AF:7DD79;?7@EFA35:;7H7F:;ED7E5D;4;@9?AD7F:3@>;FD7EB7D

    63K;@5D73E7EF:7D;E=A8:KBA@3FD37?;3+:7E73D7;@;F;3>BD7E5D;BF;A@E3@6

    8GDF:7DBD7E5D;BF;A@EE:AG>6479G;6764K?A@;FAD;@9

    A@E;67D67>;H7D;@9 -RG;6E8ADDAGF;@7?3;@F7@3@576GD;@963KF;?7:AGDEFA

    BDA?AF7E>77B3@6I7>>47;@9

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg32http://www.nice.org.uk/guidance/cg32
  • ($%&+&) "*+)",+"&

    675FDA>KF767Q5;FEAD7J57EE7EA@9A;@9>AEE7E

    E77;39D3?A8A@9A;@9>AEE7EAD34@AD?3>6;EFD;4GF;A@

    *77= 7JB7DF:7>B;8B3F;7@FE:3H735A?B>7JRG;63@6AD7>75FDA>KF7

    D76;EFD;4GF;A@;EEG7AD;?43>3@57ADE;9@;Q53@F5A?AD4;6;FK8AD7J3?B>7

    9DAEEA767?3

    E7H7D7E7BE;E

    : KBA@3FD37?;3AD:KB7D@3FD37?;3

    D7@3>>;H7D3@6AD53D6;35;?B3;D?7@F

    BAEFAB7D3F;H7RG;6D7F7@F;A@3@6D76;EFD;4GF;A@

    ?3>@AGD;E:763@6D78776;@9;EEG7EE77%GFD;F;A@EGBBADF;@36G>FE1% 5>;@;53>

    9G;67>;@72

    )"&"& &,+"&

    AEB;F3>EE:AG>67EF34>;E:EKEF7?EFA7@EGD7F:3F3>>:73>F:53D7BDA87EE;A@3>E

    ;@HA>H76;@BD7E5D;4;@93@667>;H7D;@9 -RG;6F:7D3BK3D7FD3;@76A@F:7

    BD;@5;B>7E5AH7D76;@F:;E9G;67>;@73@63D7F:7@8AD?3>>K3EE7EE763@6

    D73EE7EE763FD79G>3D;@F7DH3>EFA67?A@EFD3F75A?B7F7@57;@

    G@67DEF3@6;@9F:7B:KE;A>A9KA8RG;63@67>75FDA>KF743>3@57;@B3F;7@FEI;F:@AD?3>

    B: KE;A>A9K3@66GD;@9;>>@7EE

    3EE7EE;@9B3F;7@FERG;63@67>75FDA>KF7@776EF:7)E)7EGE5;F3F;A@)AGF;@7

    ?3;@F7@3@57)7B>357?7@F)76;EFD;4GF;A@3@6)73EE7EE?7@F

    3EE7EE;@9F:7D;E=E47@7QFE3@6:3D?EA8 -RG;6E

    BD7E5D;4;@93@636?;@;EF7D;@9 -RG;6E

    ?A@;FAD;@9F:7B3F;7@FD7EBA@E7

    7H3>G3F;@93@66A5G?7@F;@95:3@97E3@63@6

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg32
  • F3=;@93BBDABD;3F735F;A@3ED7CG;D76

    73>F:53D7BDA87EE;A@3>EE:AG>6D757;H7FD3;@;@93@676G53F;A@34AGF3@647

    5A?B7F7@F;@D75A9@;E;@93EE7EE;@93@6BD7H7@F;@95A@E7CG7@57EA8

    ?;E?3@3976 -RG;6F:7D3BK;@5>G6;@9

    BG>?A@3DKA767?3

    B7D;B:7D3>A767?3

    HA>G?767B>7F;A@3@6E:A5=

    AEB;F3>EE:AG>6:3H73@ -RG;6E>736D7EBA@E;4>78ADFD3;@;@95>;@;53>

    9AH7D@3@573G6;F3@6D7H;7IA8 -RG;6BD7E5D;4;@93@6B3F;7@FAGF5A?7E

    ;39D;39D3?A8A@9A;@9>AEE7E3?A8A@9A;@9>AEE7E

    AI@>A36F:7 :7D7

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174/resources/cg174-intravenous-fluid-therapy-in-adults-in-hospital-diagram-of-ongoing-losses
  • *AGD57ABKD;9:FO%3F;A@3>>;@;53>G;67>;@77@FD7

    #! %$"($#! &$#"" #

    !#"!"!%

  • A@E7CG7@57EA8RG;6?;E?3@397?7@FFA47D7BADF763E5D;F;53>;@5;67@FEA@E7CG7@57EA8RG;6?;E?3@397?7@FFA47D7BADF763E5D;F;53>;@5;67@FE

    A@E7CG7@57A8A@E7CG7@57A8

    RG;6RG;6

    ?;E?3@397?7@F?;E?3@397?7@F

    67@F;8K;@9873FGD7E 67@F;8K;@9873FGD7E +;?78D+;?78D3?7A83?7A8

    ;67@F;Q53F;A@;67@F;Q53F;A@

    KBAHA>37?;3 3F;7@FERG;6@776E@AF?7F4KAD3>7@F7D3>

    AD -;@F3=7 3@63@6

    73FGD7EA867:K6D3F;A@A@5>;@;53>

    7J3?;@3F;A@

    #AIGD;@7AGFBGFAD5A@57@FD3F76GD;@7

    ;A5:7?;53>;@6;53FADEEG5:3E?AD7F:3@

    ;@5D73E7;@GD73AD5D73F;@;@7I;F:@A

    AF:7D;67@F;Q34>753GE7

    78AD73@66GD;@9 -RG;6

    F:7D3BK

    G>?A@3DK

    A767?3

    4D73F:>7EE@7EE

    6GD;@9;@8GE;A@

    %AAF:7DA4H;AGE53GE7;67@F;Q768AD

    7J3?B>7B@7G?A@;3BG>?A@3DK7?4A>GEAD

    3EF:?3

    73FGD7EA8BG>?A@3DKA767?3A@5>;@;53>

    7J3?;@3F;A@

    73FGD7EA8BG>?A@3DKA767?3A@/D3K

    GD;@9 -RG;6F:7D3BKAD

    I;F:;@ :AGDEA8

    EFABB;@9 -RG;6E

    KBA@3FD37?;3 *7DG?EA6;G?>7EEF:3@??A>>

    %AAF:7D>;=7>K53GE7A8:KBA@3FD37?;3

    ;67@F;Q76

    GD;@9 -RG;6F:7D3BKAD

    I;F:;@ :AGDEA8

    EFABB;@9 -RG;6E

    KB7D@3FD37?;3 *7DG?EA6;G? ??A>>AD?AD7

    3E7>;@7EA6;G?@AD?3>AD>AI

    -RG;6D79;?7@;@5>G676EA6;G?

    5:>AD;67

    %AAF:7D>;=7>K53GE7A8:KB7D@3FD37?;3

    ;67@F;Q76

    GD;@9 -RG;6F:7D3BKAD

    I;F:;@ :AGDEA8

    EFABB;@9 -RG;6E

    #! %$"($#! &$#"" #

    !#"!"!%

  • 7D;B:7D3>

    A767?3

    ;FF;@9A767?3;@7JFD7?;F;7E3@6AD>G?43D

    E35D3>3D73

    %AAF:7DA4H;AGE53GE7;67@F;Q768AD

    7J3?B>7@7B:DAF;5EK@6DA?7AD=@AI@

    53D6;3583;>GD7

    GD;@9 -RG;6F:7D3BKAD

    I;F:;@ :AGDEA8

    EFABB;@9 -RG;6E

    KB7D=3>37?;3 *7DG?BAF3EE;G??AD7F:3@??A>>

    %AAF:7DA4H;AGE53GE7;67@F;Q76

    GD;@9 -RG;6F:7D3BKAD

    I;F:;@ :AGDEA8

    EFABB;@9 -RG;6E

    KBA=3>37?;3 *7DG?BAF3EE;G?>7EEF:3@??A>>>;=7>K

    FA476G7FA;@8GE;A@A8RG;6EI;F:AGF

    367CG3F7BAF3EE;G?BDAH;E;A@

    %AAF:7DA4H;AGE53GE78AD7J3?B>7

    BAF3EE;G?I3EF;@96;GD7F;5ED78776;@9

    EK@6DA?7

    GD;@9 -RG;6F:7D3BKAD

    I;F:;@ :AGDEA8

    EFABB;@9 -RG;6E

    *AGD57+:;EF34>7I3E6D38F7643E76A@F:75A@E7@EGE675;E;A@A8F:7?7?47DEA8F:7G;67>;@7

    7 H7>AB?7@FDAGB

    -RG;6BD7E5D;BF;A@4 -RG;6BD7E5D;BF;A@4K4A6KI7;9:F8ADDAGF;@7?3;@F7@3@57AK4A6KI7;9:F8ADDAGF;@7?3;@F7@3@57AHH7D3:AGDB7D;A67D3:AGDB7D;A6

    A6KA6K

    I7;9:FI7;9:F

    .. 3F7D3F7D *A6;G?5:>AD;67*A6;G?5:>AD;67

    BAF3EE;G?BAF3EE;G?

    A6KA6K

    I7;9:FI7;9:F

    .. 3F7D3F7D *A6;G?5:>AD;67*A6;G?5:>AD;67

    BAF3EE;G?BAF3EE;G?

    =9=9 O?>O?>

    =963=963KK

    3BBDA3BBDAJJ ??A>=9??A>=9

    6363KA8735:KA8735:

    =9=9 O?>O?>

    =963=963KK

    3BBDA3BBDAJJ ??A>=9??A>=9

    6363KA8735:KA8735:

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    #! %$"($#! &$#"" #

    !#"!"!%

  • O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    O O

    66O9D 3?E63K9>G5AE7799>G5AE75A@F3;@E9?>

    ADEB75;3>5A@E;67D3F;A@ED787DFAF:7D75A??7@63F;A@E8ADDAGF;@7?3;@F7@3@57

    #! %$"($#! &$#"" #

    !#"!"!%

  • *AGD57+:;EF34>7I3E6D38F7643E76A@F:75A@E7@EGE675;E;A@A8F:7?7?47DEA8F:7G;67>;@7

    7 H7>AB?7@FDAGB

    1 2 3EE;H7>79D3;E;@9;E3476E;67?7F:A6FA3EE7EERG;6D7EBA@E;H7@7EE;@3B3F;7@F F;E47EF

    G@67DF3=7@I;F:F:7B3F;7@F;@;F;3>>KE7?;D75G?47@F3@6F:7@F;>F;@9F:77@F;D7476F:DAG9:N

    >F7D@3F;H7>K;F53@476A@74K>K;@9F:7B3F;7@FR3F3@6B3EE;H7>KD3;E;@9F:7;D>79EFA9D73F7DF:3@

    N 83FO E75A@6EF:7B3F;7@FE:AIEE;9@EA8:37?A6K@3?;5;?BDAH7?7@F;F;@6;53F7EF:3F

    HA>G?7D7B>357?7@F?3K47D7CG;D76 8F:75A@6;F;A@A8F:7B3F;7@F67F7D;AD3F7E;@B3DF;5G>3D

    4D73F:>7EE@7EE;F;@6;53F7EF:3FF:7B3F;7@F?3K47RG;6AH7D>A3676

    #! %$"($#! &$#"" #

    !#"!"!%

  • )7E73D5:D75A??7@63F;A@E)7E73D5:D75A??7@63F;A@E

    +:7G;67>;@77H7>AB?7@FDAGB:3E?367F:78A>>AI;@9D75A??7@63F;A@E8ADD7E73D5:43E76

    A@;FED7H;7IA87H;67@57FA;?BDAH7% 9G;63@573@6B3F;7@F53D7;@F:78GFGD7+:7G;67>;@7

    7 H7>AB?7@FDAGBE8G>>E7FA8D7E73D5:D75A??7@63F;A@E;E67F3;>76;@F:78G>>9G;67>;@7

    ****%&+&%&"+)"&

    .:3F;EF:7;@5;67@57A85A?B>;53F;A@E6GD;@93@63E35A@E7CG7@57A8 -RG;6F:7D3BK

    .:.: KF:;E;E;?BADF3@FKF:;E;E;?BADF3@F

    +:;E;E3>?AEF57DF3;@>KG@67DD7BADF76;@F:7I3D6E7FF;@9I;F:E;9@;Q53@F;?B>;53F;A@E8AD

    B3F;7@FEBD76A?;@3@F>K?AD4;6;FKF:DAG9:FA?ADF3>;FK F;EBDA434>7F:3F5A?B>;53F;A@EA8RG;6

    F:7D3BK3D78D7CG7@F3@6?3K473EEA5;3F76I;F:;@5D73E765>;@;53>@776EEG5:3E5D;F;53>53D73@6

    A@A553E;A@?3K@757EE;F3F7RG;6D7EGE5;F3F;A@#35=A83E7FA85>73D>K67Q@76873FGD7EA8F:7

    5A?B>;53F;A@EA8RG;6?;E?3@397?7@F5A?BAG@6EF:7BDA4>7? F;E;?BADF3@FFA67Q@7F:7E7

    873FGD7E3@6F:7@G@67DF3=73@A4E7DH3F;A@3>EFG6K;@3:AEB;F3>E7FF;@9FA67F7D?;@7F:7

    7B;67?;A>A9KA8F:7E75A?B>;53F;A@E*G5:3EFG6KIAG>6:;9:>;9:FF:7BD7H3>7@57A8RG;6D7>3F76

    5A?B>;53F;A@E3@6;@8AD?F:767H7>AB?7@FA8BD7H7@F;H7?73EGD7E

    2,"+!) (0)2,") *,*"++"&

    D743>3@576EA>GF;A@EEGB7D;ADFAEA6;G?5:>AD;678ADF:7RG;6D7EGE5;F3F;A@A8B3F;7@FEI;F:

    35GF7:KBAHA>37?;5E:A5=

    .:.: KF:;E;E;?BADF3@FKF:;E;E;?BADF3@F

    : KE;A>A9;53>EFG6;7E>3D975A:ADFEFG6;7E3@6E?3>>D3@6A?;E76EFG6;7E:3H7E:AI@F:3F43>3@576

    5DKEF3>>A;6E?3K47EGB7D;ADFAEA6;G?5:>AD;678ADF:7FD73F?7@FA8EGD9;53>B3F;7@FE

    AI7 H7DF:7CG3>;FKA8F:77H;67@57;EBAAD+:7E7EFG6;7E:3H7E:AI@F:3FI:7@5A?B3D76I;F:

    EA6;G?5:>AD;67F:7D7;E>7EE6;EFGD43@57;@35;6O43E743>3@57:KB7D5:>AD37?;535;6AE;E

    35GF7=;6@7K;@D7B>357?7@FF:7D3BK4>AA6>AEE3@6AH7D3>>5A?B>;53F;A@

    D3F7EI;F:43>3@5765DKEF3>>A;6EAI7H7D>3D97D3@6A?;E76FD;3>E:3H7E:AI@F:3F5DKEF3>>A;6E3D7

    EGB7D;ADFA5A>>A;6E8ADRG;6D7EGE5;F3F;A@ @F:7E7EFG6;7E5A>>A;6EI7D79;H7@8ADBDA>A@976

    B7D;A6EA8F;?73@6F:79DAGBEA8B3F;7@FE;@5>G676I7D7:7F7DA97@AGE+:7BDABAE76FD;3>I;>>:7>B

    H3>;63F7I:7F:7DF:763F393F:7D768DA?B:KE;A>A9;53>EFG6;7E3@65A:ADFEFG6;7EF:3F5A?B3D76

    EA6;G?5:>AD;67I;F:43>3@5765DKEF3>>A;6EFD3@E>3F7;@FAD7>7H3@F5>;@;53>47@7QF;@B3F;7@FE

    @776;@935GF7RG;6D7EGE5;F3F;A@3@6I;>>473H3>G34>79G;67FA5>;@;53>BD35F;57

    #! %$"($#! &$#"" #

    !#"!"!%

  • 2,"+!) (0)2,") *,*"++"&

    D743>3@5765DKEF3>>A;6EEGB7D;ADFA35A?4;@3F;A@A8343>3@5765DKEF3>>A;63@6397>3F;@

    EGEB7@676;@343>3@576EA>GF;A@8ADF:7RG;6D7EGE5;F3F;A@A8B3F;7@FEI;F:35GF7:KBAHA>37?;5

    E:A5=

    .:.: KF:;E;E;?BADF3@FKF:;E;E;?BADF3@F

    )757@F>3D97D3@6A?;E765A@FDA>>76FD;3>EEG997EFF:3F5DKEF3>>A;6EEA6;G?5:>AD;67AD

    43>3@576EA>GF;A@E3D7EGB7D;ADFA:K6DAJK7F:K>EF3D5:8ADRG;6D7EGE5;F3F;A@$ADF3>;FK3@6

    5A?B>;53F;A@D3F7E7EB75;3>>KD7@3>5A?B>;53F;A@E?3K47;@5D73E76I;F::K6DAJK7F:K>EF3D5:

    AI7 H7DF:7D7;E3>35=A89AA6CG3>;FK7H;67@57A@F:7GE7A897>3F;@8ADRG;6D7EGE5;F3F;A@*A?7

    D3@6A?;E765A@FDA>>76FD;3>E:3H7E:AI@F:3FI:7@5A>>A;6E3D7GE768ADRG;6D7EGE5;F3F;A@

    HA>G?7EA8RG;6D7CG;D76?3K47>7EEF:3@I;F:5DKEF3>>A;6E F?GEF47D7?7?47D76F:3F5A>>A;6E

    53@@AF47GE767J5>GE;H7>K8ADRG;6D7EGE5;F3F;A@3@6F:3FEA?78D77I3F7D?GEF47BDAH;6763@6

    F:7D73D7>;?;F7663F3A@F:7GE7A897>3F;@E8ADRG;6D7EGE5;F3F;A@+:7BDABAE76FD;3>I;>>:7>B

    ;@8AD?I:7F:7D35A?4;@3F;A@A897>3F;@3@65DKEF3>>A;6;EEGB7D;ADFA5DKEF3>>A;63>A@78ADF:7RG;6

    D7EGE5;F3F;A@A8B3F;7@FEI;F:35GF7:KBAHA>37?;5E:A5=

    2,"+!) (0)) ,+"&%"&+&&

    A7E3:;9:7DEA6;G?5A@F7@F -RG;6D79;?7@8AD?3;@F7@3@57D76G57F:7D;E=A867H7>AB;@9

    : KBA@3FD37?;33@6HA>G?767B>7F;A@I;F:AGF;@5D73E;@9F:7D;E=A8HA>G?7AH7D>A36;@:AEB;F3>;E76

    36G>FE

    .:.: KF:;E;E;?BADF3@FKF:;E;E;?BADF3@F

    3F;7@FEI:A53@@AF?77FF:7;D63;>K@776EA8RG;6E3@67>75FDA>KF7EF:DAG9:AD3>AD7@F7D3>DAGF7E

    4GF3D7AF:7DI;E77GHA>37?;5A8F7@@776 -RG;6F:7D3BK8AD?3;@F7@3@57+:7?AEF5A??A@

    5A?B>;53F;A@EA8F:;EF:7D3BK3D7:KBA@3FD37?;3;87J57EE;H7 -I3F7D;E36?;@;EF7D76HA>G?7

    AH7D>A36;87J57EE;H7EA6;G?3@6I3F7D3D736?;@;EF7D763@6HA>G?767B>7F;A@3@6AD35GF7

    =;6@7K;@;E:76FD;3>E

    5A@E;67D;@9I:3FF:7ABF;?3> -RG;6D79;?7@8AD?3;@F7@3@57;E

    D3@6A?;E765A@FDA>>76FD;3>;E@77676FA5A?B3D7 -RG;6?3;@F7@3@57D79;?7@EI;F:6;887D7@F

    EA6;G?5A@57@FD3F;A@E8AD7J3?B>75A?B3D;EA@47FI77@EA6;G?5:>AD;67;@9>G5AE7

    3@6EA6;G?5:>AD;67;@9>G5AE7EA>GF;A@E;@F7D?EA8F:734AH767F3;>765A?B>;53F;A@

    D3F7E5AEF3@6AF:7D5>;@;53>AGF5A?7E8AD7J3?B>7>7@9F:A8EF3K+:7B3F;7@F9DAGBI;>>47

    :7F7DA97@7AGE3@63@3>KE;EE:AG>65A@E;67D4AF:?76;53>3@6EGD9;53>B3F;7@FE

    #! %$"($#! &$#"" #

    !#"!"!%

  • )"&"& &,+"&

    A7EF:7;@FDA6G5F;A@A8:AEB;F3>EKEF7?EF:3F7@EGD7

    3>>:AEB;F3>:73>F:53D7BDA87EE;A@3>E;@HA>H76;@BD7E5D;4;@93@667>;H7D;@9 -RG;6F:7D3BK3D7

    3BBDABD;3F7>KFD3;@76;@F:7BD;@5;B>7EA8RG;6BD7E5D;4;@93@63@6

    3>> -RG;6F:7D3BKD7>3F765A?B>;53F;A@E3D7D7BADF76

    >736FA3D76G5F;A@;@ -RG;6D7>3F765A?B>;53F;A@E3@63EEA5;3F76:73>F:53D75AEFE

    .:.: KF:;E;E;?BADF3@FKF:;E;E;?BADF3@F

    7EB;F7F:7835FF:3F3EE7EE?7@FA83B3F;7@FE -RG;6@776E3@6BD7E5D;BF;A@A83@3BBDABD;3F7 -

    RG;6D79;?7@53@475A?B>7JF:7793F76FA:73>F:53D7BDA87EE;A@3>EI;F:>;?;F76

    7JB7D;7@573@6>;FF>7AD@AD7>7H3@FFD3;@;@9DDADE;@BD7E5D;4;@9 -RG;6E3@67>75FDA>KF7E3D7

    F:AG9:FFA475A??A@3@63EEA5;3F76I;F:G@@757EE3DK?AD4;6;FK?ADF3>;FK3@6;@5D73E76

    :73>F:53D75AEFE+:7BDA4>7?E3D7?AEF>;=7>KFAA55GD;@7?7D97@5K67B3DF?7@FE35GF7

    36?;EE;A@G@;FE3@6?76;53>3@6EGD9;53>I3D6ED3F:7DF:3@AB7D3F;@9F:73FD7E3@65D;F;53>53D7

    G@;FEE;@57F:7EF388;@?AD797@7D3>:AEB;F3>3D73E:3H7>7EED7>7H3@F7JB7DF;E73@6EF3@63D6EA8

    D75AD6;@93@6?A@;FAD;@9A8 -RG;63@67>75FDA>KF7F:7D3BK53@47BAAD @366;F;A@F:7

    5A@E7CG7@57EA8 -RG;6?;E?3@397?7@F3D7@AFI;67>KD7BADF76 FIAG>647GE78G>FAG@67DF3=7

    F:;EEFG6KFA7H3>G3F73@63G6;FF:778875FEA8;@FDA6G5;@9FD3;@;@93@69AH7D@3@57;@;F;3F;H7E;@F:7

    %*

    #! %$"($#! &$#"" #

    !#"!"!%

  • &F:7D;@8AD?3F;A@&F:7D;@8AD?3F;A@

    (&!.+!"* ,"$"&.*- $(

    % 9G;67>;@7E3D767H7>AB76;@355AD63@57I;F:3E5AB7F:3F67Q@7EI:3FF:79G;67>;@7I;>>3@6

    I;>>@AF5AH7D

    AIF:;E9G;67>;@7I3E67AIF:;E9G;67>;@7I3E67HH7>AB767>AB76

    % 5A??;EE;A@76F:7%3F;A@3>>;@;53>G;67>;@77@FD7FA67H7>ABF:;E9G;67>;@7+:7

    7@FD77EF34>;E:763G;67>;@77H7>AB?7@FDAGBE77E75F;A@I:;5:D7H;7I76F:7

    7H;67@573@667H7>AB76F:7D75A??7@63F;A@E

    +:7?7F:A6E3@6BDA57EE7E8AD67H7>AB;@9% 5>;@;53>9G;67>;@7E3D767E5D;476;@+:7

    9G;67>;@7E?3@G3>

    $+ ,"&

    7F3;>E3D75ADD75F3FF:7F;?7A8BG4>;53F;A@A8F:79G;67>;@7757?47D GDF:7D

    ;@8AD?3F;A@;E3H3;>34>7A@F:7% I74E;F7

    G4>;E:76G4>;E:76

    &)&) $$

    3F;7@F7JB7D;7@57;@36G>F%*E7DH;57E% 5>;@;53>9G;63@57

    $76;5;@7E36:7D7@57% 5>;@;53>9G;63@57

    &"+"&*("1&"+"&*("1

    5GF7=;6@7K;@;@;53>9G;67>;@7

    D7H7@F;A@3@65A@FDA>A8:73>F:53D73EEA5;3F76;@875F;A@E% BG4>;5:73>F:CG3>;FK

    ;?BDAH7?7@F9G;67

    7>;D;G?% 5>;@;53>9G;67>;@7

    :DA@;5=;6@7K6;E73E7% 5>;@;53>9G;67>;@7+:;E9G;63@57;E5GDD7@F>K47;@9

    GB63F76

    5GF7>K;>>B3F;7@FE;@:AEB;F3>% 5>;@;53>9G;67>;@7

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174/resources/intravenous-fluid-therapy-scopehttp://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/nice-clinical-guidelineshttp://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/nice-clinical-guidelineshttp://www.nice.org.uk/http://www.nice.org.uk/guidance/cg138http://www.nice.org.uk/guidance/cg76http://www.nice.org.uk/guidance/cg169http://www.nice.org.uk/guidance/ph36http://www.nice.org.uk/guidance/cg103http://www.nice.org.uk/guidance/cg73http://www.nice.org.uk/guidance/cg50
  • &47E;FK% 5>;@;53>9G;67>;@7

    %GFD;F;A@EGBBADF;@36G>FE% 5>;@;53>9G;67>;@7

    +KB76;347F7E% 5>;@;53>9G;67>;@7

    D7:AEB;F3>;@;F;3F;A@A8RG;6D7B>357?7@FF:7D3BK;@FD3G?3% F75:@A>A9K3BBD3;E3>

    9G;63@57

    ,@67D67,@67D67HH7>AB?7@F7>AB?7@F

    % ;E67 H7>AB;@9F:78A>>AI;@99G;63@5767F3;>E3H3;>34>78DA?F:7% I74E;F7

    +D3@E8GE;A@% 5>;@;53>9G;67>;@7G4>;53F;A@7JB75F76$3K

    $39G;67>;@7

    G4>;53F;A@7JB75F76!G@7

    +KB76;347F7EGB63F7% 5>;@;53>9G;67>;@7G4>;53F;A@7JB75F76G9GEF

    @FD3H7@AGERG;6F:7D3BK;@5:;>6D7@% 5>;@;53>9G;67>;@7G4>;53F;A@7JB75F76%AH7?47D

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg43http://www.nice.org.uk/guidance/cg32http://www.nice.org.uk/guidance/cg15http://www.nice.org.uk/guidance/ta74http://www.nice.org.uk/http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0663http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0642http://www.nice.org.uk/guidance/indevelopment/gid-cgwaver122http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0655
  • +:7G;67>;@77+:7G;67>;@77HH7>AB?7@FDAGB%3F;A@3>A>>34AD7>AB?7@FDAGB%3F;A@3>A>>34AD3F;@97@FD73F;@97@FD73@6% BDA*FDAG6

    :3;D A@EG>F3@F;@3EFDA7@F7DA>A9K3@67@7D3>;@F7D@3>$76;5;@7*AGF:3?BFA@,@;H7DE;FK

    AEB;F3>E%*+DGEF

    )77?>!3)77?>!3 KKKKAGE;AGE;

    A@EG>F3@F%7B:DA>A9;EF#7;57EF7D7@7D3>AEB;F3>

    3G>AA=3G>AA=

    A@EG>F3@F;@:7?;53>3F:A>A9K*AGF:3?BFA@,@;H7DE;FKAEB;F3>E%*+DGEF

    );5:3D6#);5:3D6#735:735:

    A@EG>F3@F:KE;5;3@;@)7EB;D3FADK3@6D;F;53>3D7GKE3@6*F+:A?3EAEB;F3>AG@63F;A@

    +DGEF#A@6A@

    ;>77B#;>77B#A4AA4A

    DA87EEADA83EFDA;@F7EF;@3>*GD97DK%AFF;@9:3?,@;H7DE;FKAEB;F3>

    ++A?$5#A?$5# AG9:>;@0;BAG9:>;@0;B

    3F;7@F3@653D7D?7?47D

    $;5:37>$KF:7@$;5:37>$KF:7@?7?47DG@F;>&5FA47D?7?47DG@F;>&5FA47D

    DA87EEADA8@37EF:7F;5E3@6D;F;53>3D7,@;H7DE;FKA>>797#A@6A@

    3FD;5=%773FD;5=%77

    A@EG>F3@F;@?7D97@5K$76;5;@73@6D;F;53>3D7$76;5;@7.:;EFA@AEB;F3>D7E5AF

    $7DE7KE;67

    !7DDK%A>3@!7DDK%A>3@?7?47D8DA?&5FA47D?7?47D8DA?&5FA47D

    A@EG>F3@F;@ @F7@E;H73D73@6@37EF:7F;5E)AK3>,@;F76AEB;F3>%*+DGEF3F:

    >7GD%ADF:>7GD%ADF:

    3F;7@F3@653D7D?7?47D

    #! %$"($#! &$#"" #

    !#"!"!%

  • "3F;7*53>7E"3F;7*53>7E

    A@EG>F3@F%GDE7D;F;53>3D7&GFD735: ?B7D;3>A>>79773>F:53D7%*+DGEF#A@6A@

    )747553*:7DD)747553*:7DD3FF3FF

    6H3@576%GDE7D35F;F;A@7D*:78Q7>6+735:;@9AEB;F3>E+DGEF

    %7;>*A@;%7;>*A@;

    A@EG>F3@F;@ @F7@E;H73D73@6@37EF:7F;5E:7>[email protected]?;@EF7DAEB;F3>#A@6A@

    $3D=+$3D=+A?>;@A?>;@

    A@EG>F3@F:3D?35;EF;@D;F;53>3D7*AGF:3?BFA@7@7D3>AEB;F3>

    /()+-"*)*++! ) ,(

    @6D7I#@6D7I#7I;@9FA@7I;@9FA@?7?47D8DA?5GF7=;6@7?7?47D8DA?5GF7=;6@7 K;@;@7K;@;@7

    A@EG>F3@F)7@3>:KE;5;3@>;@;53>*G473@#776E+735:;@9AEB;F3>E

    $;5:37>$KF:7@8DA?&5FA47D$;5:37>$KF:7@8DA?&5FA47D

    DA87EEADA8@37EF:7F;5E3@6D;F;53>3D7,@;H7DE;FKA>>797#A@6A@

    +"&$$"&"$,"$"&&+)

    !A3@@3E:7!A3@@3E:7

    *7@;AD @8AD?3F;A@*5;7@F;EF

    3@G>>A5= 3@G>>A5=

    G;67>;@7#736O:;78&B7D3F;@9&8Q57D

    *?;F3*?;F3 36:;36:;

    *7@;AD)7E73D5:7>>AIDA;@9A@67D>;@9

    73>F:5A@A?;5E#736

    -- 3DA";DF:;3DA";DF:;

    AABF76+75:@;53>+73?$7?47D

    #! %$"($#! &$#"" #

    !#"!"!%

  • #;>;3@#;#;>;3@#;

    73>F:5A@A?;EF8DA?!G>KFA74DG3DK

    %;@33>35:3@67D%;@33>35:3@67D

    *7@;AD)7E73D5:7>>AI8DA?$3D5:FABD;>

    *7D7@33DH;>>7*7D7@33DH;>>7

    *7@;AD)7E73D5:7>>AIDA>AI8DA?!G>KFA757?47D

    !7@@;87D#3!7@@;87D#3KK67@67@

    *7@;ADDAKFA!G>K

    !G>;7%7;>EA@!G>;7%7;>EA@

    *7@;AD)7E73D5:7>>AIDAK

    *3D*3D3G5=@7D3G5=@7D

    )7E73D5:7>>AI8DA?!G>KFABD;>

    *GE3@#3F5:7?*GE3@#3F5:7?

    G;67>;@7#736O&B7D3F;A@E;D75FAD8DA?757?47DFA%AH7?47D

    () #++%

    *:3DA@*G??7DE$3*:3DA@*G??7DE$3

    EEA5;3F7;D75FAD

    $3D=3=$3D=3=7D7D

    >;@;53>6H;E7D

    >;88AD6$;66>7FA@>;88AD6$;66>7FA@

    G;67>;@7A??;EE;A@;@9$3@397DG@F;>$3K

    >3;D7)G;L>3;D7)G;L

    G;67>;@7A??;EE;A@;@9$3@397D8DA?$3K

    #! %$"($#! &$#"" #

    !#"!"!%

  • >3;@7>K>3;@7>K67E63>767E63>7

    G;67>;@7AAD6;@3FAD

    *F7*F7HH7@3D@7E7@3D@7E

    +75:@;53>#736

    !3E677B3!3E677B3KD7KD7

    73>F:5A@A?;EF

    *3D*3D3:3: 3>A?47>>33>A?47>>3

    *7@;AD$76;53>6;FAD

    #! %$"($#! &$#"" #

    !#"!"!%

  • 4AGFF:;E9G;67>;@74AGFF:;E9G;67>;@7

    % 5>;@;53>9G;67>;@7E3D7D75A??7@63F;A@E34AGFF:7FD73F?7@F3@653D7A8B7AB>7I;F:EB75;Q5

    6;E73E7E3@65A@6;F;A@E;@F:7%*;@@9>3@[email protected]>7E

    % 9G;67>;@7E3D767H7>AB76;@355AD63@57I;F:3E5AB7F:3F67Q@7EI:3FF:79G;67>;@7I;>>3@6

    I;>>@AF5AH7D

    +:;E9G;67>;@7I3E67H7>AB764KF:7%3F;A@3>>;@;53>G;67>;@77@FD7I:;5:;E43E763FF:7)AK3>

    A>>797A8:KE;5;3@E+:77@FD7IAD=76I;F:3G;67>;@77H7>AB?7@FDAGB5A?BD;E;@9

    :73>F:53D7BDA87EE;A@3>E;@5>G6;@95A@EG>F3@FEE3@6@GDE7EB3F;7@FE3@653D7DE3@6F75:@;53>

    EF388I:;5:D7 H;7I76F:77H;67@573@66D38F76F:7D75A??7@63F;A@E+:7D75A??7@63F;A@EI7D7

    Q@3>;E7638F7DBG4>;55A@EG>F3F;A@

    +:7?7F:A6E3@6BDA57EE7E8AD67H7>AB;@9% 5>;@;53>9G;67>;@7E3D767E5D;476;@+:79G;67>;@7E

    ?3@G3>

    +)& +!) %%&+"&*

    *A?7D75A??7@63F;A@E53@47?367I;F:?AD757DF3;@FKF:3@AF:7DE+:7G;67>;@77H7>AB?7@F

    DAGB?3=7E3D75A??7@63F;A@43E76A@F:7FD367A8847FI77@F:747@7QFE3@6:3D?EA83@

    ;@F7DH7@F;A@F3=;@9;@FA355AG@FF:7CG3>;FKA8F:7G@67DB;@@;@97H;67@57ADEA?7;@F7DH7@F;A@E

    F:7G;67>;@77H7>AB?7@FDAGB;E5A@Q67@FF:3F9;H7@F:7;@8AD?3F;A@;F:3E>AA=763F?AEF

    B3F;7@FEIAG>65:AAE7F:7;@F7DH7@F;A@+:7IAD6;@9GE76;@F:7D75A??7@63F;A@E;@F:;E9G;67>;@7

    67@AF7EF:757DF3;@FKI;F:I:;5:F:7D75A??7@63F;A@;E?367F:7EFD7@9F:A8F:7

    D75A??7@63F;A@

    AD3>>D75A??7@63F;A@E% 7JB75FEF:3FF:7D7;E6;E5GEE;A@I;F:F:7B3F;7@F34AGFF:7D;E=E3@6

    47@7QFEA8F:7;@F7DH7@F;A@E3@6F:7;DH3>G7E3@6BD787D7@57E+:;E6;E5GEE;A@3;?EFA:7>BF:7?FA

    D735:38G>>K;@8AD?76675;E;A@E773>EA 3F;7@F57@FD7653D7

    @F7DH @F7DH7@F;A@EF:3F?GEF7@F;A@EF:3F?GEFAD?GEF@AF47GE76AD?GEF@AF47GE76

    . 7GEG3>>KGE7?GEFAD?GEF@AFA@>K;8F:7D7;E3>793>6GFKFA3BB>KF:7D75A??7@63F;A@

    &553E;A@3>>KI7GE7?GEFAD?GEF@AF;8F:75A@E7CG7@57EA8@AF8A>>AI;@9F:7

    D75A??7@63F;A@5AG>6477JFD7?7>KE7D;AGEADBAF7@F;3>>K>;87F:D73F7@;@9

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174/resources/intravenous-fluid-therapy-scopehttp://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/nice-clinical-guidelineshttp://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/nice-clinical-guidelineshttp://www.nice.org.uk/guidance/cg174/chapter/patient-centred-care
  • @F7DH @F7DH7@F;A@EF:3FE:AG>67@F;A@EF:3FE:AG>6ADE:AG>6@AF47GE76O3EFDA@9D75A??7@63F;A@ADE:AG>6@AF47GE76O3EFDA@9D75A??7@63F;A@

    . 7GE7A887D3@6E;?;>3DIAD6EEG5:3ED787DAD36H;E7I:7@I73D75A@Q67@FF:3F8ADF:7H3EF

    ?3>6A?AD79AA6F:3@:3D?3@6475AEF78875F;H7. 7GE7

    E;?;>3D8AD?EA8IAD6E8AD7J3?B>7A@AFA887DPI:7@I73D75A@Q67@FF:3F3@;@F7DH7@F;A@

    I;>>@AF47A847@7QF8AD?AEFB3F;7@FE

    @F7DH @F7DH7@F;A@EF:3F5AG>647GE767@F;A@EF:3F5AG>647GE76

    . 7GE75A@E;67DI:7@I73D75A@Q67@FF:3F3@;@F7DH7@F;A@I;>>6A?AD79AA6F:3@:3D?8AD

    ?AEFB3F;7@FE3@6475AEF78875F;H74GFAF:7DABF;A@E?3K47E;?;>3D>K5AEF78875F;H7+:75:A;57A8

    ;@F7DH7@F;A@3@6I:7F:7DAD@AFFA:3H7F:7;@F7DH7@F;A@3F3>>;E?AD7>;=7>KFA67B7@6A@F:7

    B3F;7@FEH3>G7E3@6BD787D7@57EF:3@8AD3EFDA@9D75A??7@63F;A@3@6EAF:7:73>F:53D7

    BDA87EE;A@3>E:AG>6EB7@6?AD7F;?75A@E;67D;@93@66;E5GEE;@9F:7ABF;A@EI;F:F:7B3F;7@F

    +!)- )*"&*+!"* ,"$"&

    +:78G>>9G;67>;@7 @FD3H7@AGERG;6F:7D3BK;@36G>FE;@:AEB;F3>5A@F3;@E67F3;>EA8F:7?7F:A6E

    3@67H;67@57GE76FA67H7>ABF:79G;67>;@7 F;EBG4>;E:764KF:7 @F7D@3>>;@;53>G;67>;@7E

    DA9D3??7

    +:7D75A??7@63F;A@E8DA?F:;E9G;67>;@7:3H7477@;@5ADBAD3F76;@FA3% 3F:I3 K

    . 7:3H7BDA6G576;@8AD?3F;A@8ADF:7BG4>;534AGFF:;E9G;67>;@7

    %($%&++"&

    ?B>7?7@F3F;A@FAA>E3@6D7EAGD57EFA:7>BKAGBGFF:79G;67>;@7;@FABD35F;573D73>EA3H3;>34>7

    ,)) *(&*""$"+0

    +:;E9G;63@57D7BD7E7@FEF:7H;7IA8% I:;5:I3E3DD;H763F38F7D53D78G>5A@E;67D3F;A@A8F:7

    7H;67@573H3;>34>773>F:53D7BDA87EE;A@3>E3D77JB75F76FAF3=7;F8G>>K;@FA355AG@FI:7@

    7J7D5;E;@9F:7;D5>;@;53>

    D7EBA@E;4;>;FKA8:73>F:53D7BDA87EE;A@3>EFA?3=7675;E;A@E3BBDABD;3F7FAF:75;D5G?EF3@57EA8

    F:7;@6;H;6G3>B3F;7@F;@5A@EG>F3F;A@I;F:F:7B3F;7@F3@6AD9G3D6;3@AD53D7D3@6;@8AD?764K

    F:7EG??3D;7EA8BDA6G5F5:3D35F7D;EF;5EA83@K6DG9E

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.uk/guidance/cg174/evidencehttp://pathways.nice.org.uk/pathways/intravenous-fluid-therapy-in-adults-in-hospitalhttp://www.nice.org.uk/guidance/cg174/informationforpublichttp://www.nice.org.uk/guidance/cg174
  • ?B>7?7@F3F;A@A8F:;E9G;63@57;EF:7D7EBA@E;4;>;FKA8>A53>5A??;EE;A@7DE3@6ADBDAH;67DE

    A??;EE;A@7DE3@6BDAH;67DE3D7D7?;@676F:3F;F;EF:7;DD7EBA@E;4;>;FKFA;?B>7?7@FF:7

    9G;63@57;@F:7;D>A53>5A@F7JF;@>;9:FA8F:7;D6GF;7EFA:3H76G7D793D6FAF:7@776FA7>;?;@3F7

    G@>3I8G>6;E5D;?;@3F;A@36H3@577CG3>;FKA8ABBADFG@;FK3@68AEF7D9AA6D7>3F;A@E%AF:;@9;@F:;E

    9G;63@57E:AG>647;@F7DBD7F76;@3I3KF:3FIAG>647;@5A@E;EF7@FI;F:5A?B>;3@57I;F:F:AE7

    6GF;7E

    (0)" !+

    M%3F;A@3> @EF;FGF78AD73>F:3@63D7J57>>7@57>>D;9:FED7E7DH76% 5AB KD;9:F

    ?3F7D;3>53@476AI@>A36768ADBD;H3F7D7E73D5:3@6EFG6K3@6?3K47D7BDA6G5768AD76G53F;A@3>

    3@6@AF8ADBDAQFBGDBAE7E%AD7BDA6G5F;A@4KAD8AD5A??7D5;3>AD93@;E3F;A@EAD8AD

    5A??7D5;3>BGDBAE7E;E3>>AI76I;F:AGFF:7ID;FF7@B7D?;EE;A@A8%

    *%

    ) "++"&

    #! %$"($#! &$#"" #

    !#"!"!%

    http://www.nice.org.ukhttp://www.nice.org.ukIntravenous fluid therapy in over 16s in hospitalContentsIntroductionPatient-centred careKey priorities for implementationPrinciples and protocols for intravenous fluid therapyAssessment and monitoringResuscitationRoutine maintenanceTraining and education1 RecommendationsTerms used in this guideline1.1 Principles and protocols for intravenous fluid therapyAlgorithms for IV fluid therapy1.2 Assessment and monitoringInitial assessmentReassessment1.3 Resuscitation1.4 Routine maintenance1.5 Replacement and redistribution1.6 Training and educationDiagram of ongoing lossesConsequences of fluid mismanagement to be reported as critical incidentsIV fluid prescription (by body weight) for routine maintenance over a 24hour period2 Research recommendations2.1 Assessment and monitoringWhy this is important2.2 IV fluid therapy for fluid resuscitationWhy this is important2.3 IV fluid therapy for fluid resuscitationWhy this is important2.4 IV fluid therapy for routine maintenanceWhy this is important2.5 Training and educationWhy this is important3 Other information3.1 Scope and how this guideline was developed3.2 Related NICE guidancePublishedGeneralCondition-specificUnder development4 The Guideline Development Group, National Collaborating Centre and NICE project team4.1 Guideline Development Group (GDG)4.2 Expert advisers to the group4.3 National Clinical Guideline Centre4.4 NICE project teamAbout this guidelineStrength of recommendationsInterventions that must (or must not) be usedInterventions that should (or should not) be used a 'strong' recommendationInterventions that could be usedOther versions of this guidelineImplementationYour responsibilityCopyrightAccreditation