Early intervention in acute renal failure: Evidence of inadequate intravenous fluid treatment in UK hospitals

doi:10.1136/bmj.333.7567.551-a

BMJ 2006;333:551 (9 September), doi:10.1136/bmj.333.7567.551-a

Letter

Early intervention in acute renal failure

Evidence of inadequate intravenous fluid treatment in UK hospitals

The first 150 words of the full text of this article appear below.

EDITOR—Bennett-Jones emphasises the importance of promptadministration of intravenous fluids for early interventionin acute renal failure.¹ Determining the appropriate rate offluid administration must include an estimate of the degreeof intravascular volume depletion at the start of treatment,with most aggressive volume expansion targeted at patients withthe greatest deficits. To determine whether this simple principleis followed in practice, we audited intravenous fluid prescriptionsfor 114 consecutive acute surgical admissions to three UK centres(one teaching hospital and two district general hospitals).

A raised ratio of blood urea to creatinine is commonly usedas a quantitative reference standard for the diagnosis of hypovolaemia,²and similar rises may be seen in patients with reduced effectiveintravascular volume secondary to sepsis.³ We therefore comparedthe initial rate of intravenous fluid administration for eachpatient with their urea:creatinine ratio on admission. We excludedfrom the analysis patients with . . . [Full text of this article]

Nicholas J Matheson, senior house officer in medicine

St Thomas' Hospital, London SE1 7EH nickmatheson@yahoo.com

Sarosh R Irani, locum registrar in medicine

John Radcliffe Hospital, Oxford OX3 9DU

Anushka Irani, clinical fellow in rheumatology

Great Western Hospital, Swindon SN3 6BB