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Information about the current guideline
The prescription of intravenous fluids requires an understanding of fluid homeostasis and should be tailored to the individual, the disease and the intended therapeutic goal. Errors in prescribing or administration can increase morbidity, with inadequate provision causing hypovolaemia and poor organ perfusion, and excessive fluids leading to overload and cardiac failure. Failing to correct electrolyte imbalances can result in neurological sequelae and even death.
In December 2015, the National Institute for Care Excellence (NICE) addressed the lack of guidance by publishing ‘Intravenous fluid therapy in children and young people in hospital NG29’1. Endorsed by the Royal College of Paediatrics and Child Health, its aim was to offer a ‘standardised approach to assessing patient’s fluid and electrolyte status and prescribing IV fluid therapy in term neonates, children and young people’.
Although there is no previous national consensus for intravenous fluid prescription in children, some guidance in certain paediatric scenarios is embedded in other NICE guidelines (see box 1).
Intravenous fluid therapy in children and young people in hospital NICE guideline, December 2015 N29, https://www.nice.org.uk/guidance/ng29/resources/intravenous-fluid-therapy-in-children-and-young-people-in-hospital-1837340295109
Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management NICE guideline CG84, April 2009, https://www.nice.org.uk/guidance/cg84
Diabetes (type 1 and type 2) in children and young people: diagnosis and management NICE clinical guideline NG18, August 2015, https://www.nice.org.uk/guidance/ng18
Fever in under 5s: assessment and in children NICE clinical guideline CG160, https://www.nice.org.uk/guidance/cg160
NICE, National Institute for Care Excellence.
Key issues that the guideline addresses
provides a standardised approach for the initial prescription of intravenous fluid in children for maintenance, fluid resuscitation and replacement/redistribution
offers standards for monitoring children who are receiving intravenous fluids
presents algorithms for the management of hypernatraemia and hyponatraemia that may develop during fluid administration.
Factors to consider prior to prescription of intravenous fluids
Risk of increased antidiuretic hormone secretion (see box 4)
Mechanical ventilation (decreases insensible …
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