Quality statement 3: Fluid type for intravenous (IV) fluid resuscitation

Quality statement

Term neonates, children and young people are not given hypotonic fluids or glucose-containing fluids for intravenous (IV) fluid resuscitation.

Rationale

There are safety concerns about the use of hypotonic IV fluids in term neonates, children and young people. They have been associated with the development of hyponatraemia (decreased sodium levels in the blood), which can increase the risk of developing brain swelling and neurological complications as a consequence of hyponatraemia. To avoid these adverse consequences, hypotonic IV fluids should not be given for fluid resuscitation.

Term neonates, children and young people should receive glucose-free crystalloids for fluid resuscitation because they are the safest option.

Quality measures

Structure

Evidence of local arrangements to ensure that term neonates, children and young people are not given hypotonic fluids or glucose-containing fluids for IV fluid resuscitation.

Data source: Local data collection.

Process

Proportion of term neonates, children and young people who are given hypotonic fluids or glucose-containing fluids for IV fluid resuscitation.

Numerator – the number in the denominator who are given hypotonic fluids or glucose-containing fluids for IV fluid resuscitation.

Denominator – the number of term neonates, children and young people receiving IV fluid resuscitation.

Data source: Local data collection.

Outcome

Incidence of hyponatraemia attributable to IV fluid therapy in term neonates, children and young people.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (hospitals) ensure that protocols are in place so that term neonates, children and young people are not given hypotonic fluids or glucose-containing fluids for IV fluid resuscitation.

Healthcare professionals (such as hospital doctors and nurse practitioners) do not give hypotonic fluids or glucose-containing fluids to term neonates, children and young people for IV fluid resuscitation.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services that do not give hypotonic fluids or glucose-containing fluids to term neonates, children and young people for IV fluid resuscitation.

What the quality statement means for patients, service users and carers

Term neonates (babies born at full term), children and young people receiving IV fluid therapy to replace lost fluids are not given a type of IV fluid called hypotonic fluid or fluids containing glucose when they start IV fluid therapy. Intravenous fluids (usually shortened to 'IV' fluids) are liquids given to replace water, sugar and salt that a person might need if they are ill or having an operation, and can't eat or drink as they would normally. IV fluids are given straight into a vein through a drip.

Source guidance

Definitions of terms used in this quality statement

Hypotonic fluids

A hypotonic fluid is a solution with a lower concentration of electrolytes than body plasma. An example of a hypotonic fluid is 0.45% sodium chloride. Although some solutions are isomolar in vitro, they are hypotonic in vivo (for example 0.45% sodium chloride with 2.5% glucose). See NICE's guideline on intravenous fluid therapy in children and young people in hospital for further examples of hypotonic and isotonic fluids.

Glucose-containing fluids

A glucose-containing fluid is either an isotonic or hypotonic fluid with glucose.

[Adapted from the NICE guideline on intravenous fluid therapy in children and young people in hospital]

Fluid resuscitation

To rapidly expand blood volume, restore or maintain blood flow to the organs can be a lifesaving intervention. IV fluid resuscitation is commonly used in term neonates, children and young people undergoing major surgery, to treat sepsis, and after severe trauma.

[Adapted from the NICE guideline on intravenous fluid therapy in children and young people in hospital]