Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Recommended fluid resuscitation protocols for managing hypovolemic shock in adult patients:
- Initial assessment should identify hypovolemia using clinical indicators such as systolic blood pressure less than 100 mmHg, heart rate over 90 bpm, capillary refill time over 2 seconds or cold peripheries, respiratory rate over 20 breaths per minute, and a National Early Warning Score (NEWS) of 5 or more. Passive leg raising can be used to assess fluid responsiveness at the bedside NICE CG174.
- For fluid resuscitation, intravenous (IV) fluids should be administered promptly to patients who cannot meet their fluid needs orally or enterally, with continuous reassessment and monitoring NICE CG174.
- In cases of hypovolemic shock due to active bleeding (haemorrhagic shock), hospital protocols recommend avoiding crystalloids and instead using blood components with a ratio of 1 unit plasma to 1 unit red blood cells for adults NICE NG39.
- In pre-hospital settings, crystalloids may be used to replace fluid volume if blood components are unavailable, but in hospital settings, blood components are preferred for active bleeding NICE NG39.
- For non-bleeding hypovolemic shock, follow the NICE guideline on intravenous fluid therapy in adults, which includes using isotonic crystalloid solutions for initial resuscitation, titrated to clinical response and ongoing monitoring NICE CG174.
- Continuous monitoring during resuscitation should include ABCDE assessment, respiratory rate, pulse, blood pressure, perfusion, venous lactate, arterial pH, and base excess as per advanced life support guidance NICE CG174.
- Fluid prescriptions must specify type, rate, and volume, and patients should have an IV fluid management plan with daily expert review initially NICE CG174.