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Open Access Research article

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

Arfon GMT Powell1*, Simon Paterson-Brown2 and Gordon B Drummond3

Author Affiliations

1 Unit of Experimental Therapeutics, College of Medical, Veterinary and Life of Sciences, University of Glasgow, 2nd Floor McGregor Building, Western Infirmary, Glasgow, G11 6NT, Scotland

2 Department of Surgery, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, Scotland

3 Department of Anaesthesia and Pain Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, Scotland

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BMC Medical Education 2014, 14:35  doi:10.1186/1472-6920-14-35

Published: 20 February 2014



Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.


We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.


The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.


Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge.

Fluid Therapy; Textbooks; Teaching; Medical graduates