Fluid therapy for anaesthetists and intensivists

The prescription of intravenous fluids is common in hospitalized patients and is increasingly recognized as a potential source of harm if administered inappropriately. The recently published NICE guideline seeks to provide a simple and consistent approach to assessing, prescribing and re-evaluating fluid status in sick patients. There has been a long-running debate regarding the optimal fluid to prescribe which has shifted in recent years to consider not only which type of fluid to prescribe but also how much and when. This article summarizes the physiology of fluid and electrolyte homeostasis and the latest evidence for each of the common fluids available. We aim to highlight specific circumstances where the choice of fluid may vary from normal practice.