It is not possible to prevent all cases of circulatory collapse but there are things that we can do on the wards to reduce the risk. Dehydration in hospital should be preventable with adequate fluid prescription.

A regular review of a patient’s medication chart is necessary to prevent inappropriate continuation of diuretic treatment. If a patient is acutely ill, it will be necessary to review the appropriateness of any anti-hypertensive treatment, which may exacerbate hypotension.

The key to preventing the sequelae of shock and poor tissue perfusion pressures is early recognition and response. Without early treatment and resuscitation the patient will continue to deteriorate and develop multiple organ failure.

One of the most sensitive organs to reduced tissue perfusion is the kidney. Therefore any patient who has a reduced urine output (< 0.5 ml/kg/hr) should have their volume status assessed and receive appropriate treatment.

Updated IV fluid guidelines can be found on the NICE website and were published in December 2013, http://www.nice.org.uk/.