Question 1 · Medical & Resuscitation · Moderate
A 55-year-old woman in the emergency department has suspected sepsis, a NEWS2 score of 8 and a systolic blood pressure of 88 mmHg. Which initial intravenous fluid regimen does NICE NG253 recommend?
- ACrystalloid 500 ml over 15 minutes, repeated in 500 ml boluses to 2,000 ml, reassessing each time
- BCrystalloid 250 ml over 10–15 minutes, repeated in 250 ml boluses to 1,000 ml, reassessing each time
- CCrystalloid 30 ml/kg over the first hour, then further boluses guided by the systolic blood pressure response
- DHuman albumin 5% 250 ml over 10–15 minutes, repeated in 250 ml boluses to 1,000 ml, reassessing
- ECrystalloid 1,000 ml over 30 minutes, then a maintenance infusion with reassessment at one hour
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Answer: B
Crystalloid 250 ml over 10–15 minutes, repeated in 250 ml boluses to 1,000 ml, reassessing each time
NICE NG253 recommends an isotonic electrolyte crystalloid — a balanced solution such as Hartmann's, or 0.9% saline if a balanced solution is not available. The initial bolus is 250 ml, ideally over 10 to 15 minutes, with further 250 ml boluses if needed up to 1,000 ml in total (including fluid already given), reassessing after each bolus. If the person has not improved enough after 1,000 ml, advice is sought from a senior clinical decision maker. For a high-risk patient such as this one (NEWS2 of 7 or more), the first bolus is given without delay, within 1 hour. The 500 ml, 30 ml/kg and 1,000 ml regimens are all larger, faster or less closely reassessed than NG253 allows, and albumin is not the recommended fluid.
Where this comes from
- NICE NG253 Suspected sepsis in people aged 16 or over: recognition, assessment and early managementNICE·Intravenous fluids: choice of fluid“use an isotonic electrolyte crystalloid solution”Open at this sentence
- NICE NG253 Suspected sepsis in people aged 16 or over: recognition, assessment and early managementNICE·Intravenous fluids: initial bolus“Give an initial bolus of 250 ml.”Open at this sentence
- NICE NG253 Suspected sepsis in people aged 16 or over: recognition, assessment and early managementNICE·Intravenous fluids: further boluses“Give further 250 ml boluses if needed, up to 1,000 ml total”Open at this sentence
- NICE NG253 Suspected sepsis in people aged 16 or over: recognition, assessment and early managementNICE·Intravenous fluids: reassessment“Reassess after each fluid bolus.”Open at this sentence
- NICE NG253 Suspected sepsis in people aged 16 or over: recognition, assessment and early managementNICE·Intravenous fluids: timing in high risk“Give an intravenous fluid bolus without delay”Open at this sentence
- NICE NG253 Suspected sepsis in people aged 16 or over: recognition, assessment and early managementNICE·Intravenous fluids: senior advice after 1,000 ml“after 1,000 ml has been given, get advice from a senior clinical decision maker”Open at this sentence