Controversies in fluid therapy: Type, dose and toxicity

Table 1 Overview of the analogy of prescribing fluid therapy and prescribing a drug

Steps for prescribing a drug	Prescribing an oral hypoglycemic medication	Prescribing fluid therapy
Define the clinical problem	Diabetes mellitus	Hypovolemia or other fluid responsive state
Specify the therapeutic objective	Lower blood glucose	Restore absolute/relative fluid deficit
Verify the suitability of the drug	Class of oral hypoglycemic agent	Crystalloid, colloid or blood product
Write a prescription to start the drug	Order written by MD, verified and dispensed by pharmacy	Order written by MD, verified by pharmacy, blood bank or RN, administered by RN
Monitor therapeutic response of the drug	Blood glucose or hemoglobin A1C, evidence of adverse effect/ toxicity	Monitor hemodynamic profile and end-organ perfusion, evidence of dose-response toxicity
Write an order to discontinue	Order written by MD, verified by pharmacy	Order written by MD, administered by RN

Adapted from Raghunathan et al[58].