Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Intravenous fluid therapy for adults in hospital: summary of NICE guidance

BMJ 2013; 347 doi: (Published 10 December 2013) Cite this as: BMJ 2013;347:f7073

Rapid Response:

Re: Intravenous fluid therapy for adults in hospital: summary of NICE guidance

It won't be long before all common sense is unnecessary and all initiative drummed out of doctors, when so many guidelines, regulations, rules and protocols are put in front of us. The authors suggest that fluid therapy practice is poor, quoting a 15 yr old document as evidence. It probably is, bearing in mind that patients on the wards at Stafford Hospital were allegedly so dry that they were drinking from flower vases. But does anyone seriously suggest that doctors who practised such basic clinical neglect will be bothered to read a set of guidelines as technical and complex as these?

If current practice is bad, its because senior clinicians, and senior trainees are not taking the time to drum the basics of fluid management into new junior doctors. You don't need complex algorithms, lactate levels or arterial gases to administer proper fluid replacement. You need to know first whether a patient has previously had a normal fluid intake, and whether the illness they have involves fluid loss. You need to know if their tongue is dry, and if they're passing decent urine volumes. Those parameters, and a few more clinical signs not even mentioned in this article will serve as a good basis to assess the vast majority of patients. Detailed articles such as this, without parallel practical observation will in my view do nothing to help patients. But then, when plastic dummies are taking over from hands-on patient care in so many areas of medical school training, its hardly surprising the new doctors can't tell a dry patient from a well-hydrated one!

Competing interests: No competing interests

09 February 2014
Peter Mahaffey
cons plastic & reconstr surgeon