Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
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Figure 5: Example <strong>of</strong> a vital signs chart showing a rising pulse rate <strong>and</strong> a falling<br />
blood pressure, indicating progressive intravascular hypovolaemia secondary<br />
to haemorrhage.<br />
Examination <strong>of</strong> the jugular filling with the patient reclining at 45°<br />
should be routine. If the level is elevated above the clavicle, this may<br />
signify intravascular over-expansion by administered fluids, congestive<br />
heart failure, or both. If, however, no jugular filling is observed,<br />
then lower the patient slowly until filling is observed. If filling is still<br />
not seen or only seen with the patient nearly horizontal, then this may<br />
signify an intravascular volume deficit.<br />
This manoeuvre is particularly valuable in assessing patients still<br />
receiving intravenous fluids some days after the acute phase <strong>of</strong> their<br />
illness has subsided <strong>and</strong> recovery is slow or accompanied by complications.<br />
Such patients may have an exp<strong>and</strong>ed extracellular fluid (ECF)<br />
with oedema due to excess crystalloid administration, but a diminished<br />
blood or plasma volume due to continuing leak <strong>of</strong> blood, protein<br />
or serous fluid into wounds or inflamed areas. These findings indicate<br />
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