Introduction Gastroenterology patients frequently require intravenous fluids but inappropriate prescription is associated with poorer outcomes (1). Educational initiatives can improve fluid prescription (2) and this study examines knowledge of electrolyte requirements and post-operative fluid prescription amongst final year medical students and junior doctors, ten years on from the paper by Lobo et al (3).

Methods 56 junior doctors and final year medical students in a large UK teaching hospital answered a questionnaire on fluid prescribing practise before attending a formal teaching session on the topic where they also received a pocket handbook on Trust prescribing guidelines. Six months later they were asked to repeat the questionnaire. There were 36 respondents after the teaching session.

Results Prior to the teaching 25% did not feel confident with fluid prescribing and 34% felt they had unsatisfactory or poor teaching at medical school. 18% stated that fluid balance charts were not checked regularly. Only 10% of respondents were aware of the sodium content of normal saline and 9% would prescribe two or more litres of normal saline per day in a post-operative patient.

After the teaching session 94% felt confident with fluid prescribing and 64% knew the sodium content of normal saline. 5% would prescribe two or more litres of normal saline per day in a post-operative patient.

Conclusion Knowledge of electrolyte requirements and fluid prescribing is still inadequate, but a teaching session with a handout significantly improved knowledge and confidence in prescribing. The six months of experience gained in this time may be a confounding factor, but as the questionnaires indicated lack of fluid chart review with seniors or other relevant teaching sessions, their main source of knowledge was postulated to be from our teaching. More attention should be given to this subject in medical schools and guidance should be given at Trust inductions.

Disclosure of Interest None Declared

References

1. Walsh SR et al. Perioperative fluid management: prospective audit. Int J Clin Pract. 2008 Mar; 62(3):492–7. Epub 2007 May 30.

2. De Silva AN et al. Improving peri-operative fluid management in a large teaching hospital: pragmatic studies on the effects of changing practise. Proceedings of the Nutrition Society 2010; 69: 499–507.

3. Lobo DN et al. Problems with solutions: drowning in the brine of an inadequate knowledge base. Clinical Nutrition 2001; 20(2):125–30.