Basic Concepts of Fluid and Electrolyte Therapy

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Urine output should be interpreted in the light of these clinical signs and measurements before giving fluid treatment, which may not only be unnecessary, but also deleterious. Unnecessary fluid therapy not only expands the blood volume excessively but also over-expands the interstitial fluid volume, causing oedema and weight gain. The metabolic response to surgery impairs the patient’s ability to excrete the additional saline load, making interstitial oedema worse, compromising organ function and increasing the risk of morbidity and mortality. Other consequences are dilution of the haematocrit and serum albumin concentration. Table 17: Assessment of volume status Capillary refill time Pulse rate Beta blockers/diltiazem (prevent tachycardia) Blood pressure Lying and standing Jugular venous pressure Skin turgor (over clavicle) Auscultate Lungs (pulmonary oedema) Heart sounds (gallop rhythm - hypervolaemia) Oedema Peripheral/sacral Urine output Weight change to assess water balance 74
Oliguria secondary to AKI Although it is important not to give excess fluid, failure to recognize and treat hypovolaemia (and pre-renal AKI) adequately may compromise organ perfusion and result in intrinsic AKI. There is evidence that patients with oliguric AKI have more severe tubular damage and a worse outcome. Once a diagnosis of AKI has been made the underlying cause must be established (Chapter 9). The most common causes are hypovolaemia and/or sepsis leading to hypoperfusion of the kidneys. Clinical examination must be performed to establish the patient's volume status and the source of sepsis must be identified and treated promptly. If the patient is hypovolaemic then appropriate fluid therapy must be given according to a documented management plan, which requires regular review and defined endpoints (Fig. 9). In a patient with hypovolaemia and oliguric AKI consider insertion of a central venous pressure (CVP) line and urinary catheter (not mandatory and could introduce infection) to aid with the assessment of volume status resuscitate with IV fluids (fluid challenge) stat fluid bolus of 500 ml (250 ml if cardiac failure) of a balanced crystalloid (e.g. Hartmann’s solution or Ringer’s lactate) rapidly. If hyperkalaemia is present (K + >5.5 mmol/l) or suspected oliguric AKI or rhabdomyolysis 0.9% saline is preferred initially (no potassium in crystalloid). However, there is no evidence that administration of crystalloids containing 3-5 mmol/l of K + worsen the hyperkalaemia. 75
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electro
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Foreword This book, ‘Basic Concep
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Table of Contents 1. Normal Physiol
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ever, contains large anions such as
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Oral intake 1.5-2 L Saliva 1.5 L Ga
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Table 2: Normal maintenance require
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Kidney: this is the main organ for
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Conversely, if the intake of Na + i
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volume at all costs. It also explai
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Conclusion Appropriate fluid therap
Page 24 and 25: Intravascular fluid volume - the to
Page 26 and 27: Colloid - a fluid consisting of mic
Page 28 and 29: Base excess - Base excess is define
Page 30 and 31: Parameter Urine output Significance
Page 32 and 33: Figure 5: Example of a vital signs
Page 34 and 35: Fluid balance charts These provide
Page 36 and 37: Osmolality In the presence of AKI,
Page 38 and 39: Chloride Despite the fact that seru
Page 41 and 42: 4. Properties of Intravenous Crysta
Page 43 and 44: 6-12 h. The colloid should be metab
Page 45 and 46: Table 8: Advantages and disadvantag
Page 47: Plasma- Sterofundin 0.18% Plasma-Ly
Page 50 and 51: 50 Patients receiving artificial nu
Page 52 and 53: Once resuscitation has been achieve
Page 54 and 55: (3) The answer to this question is
Page 57 and 58: 6. Methods of Fluid Administration
Page 59 and 60: Central Modern single or multi lume
Page 61 and 62: 7. Acid-Base Balance Introduction M
Page 63 and 64: vide a simple description of the mo
Page 65 and 66: change in Pco 2 = respiratory proce
Page 67 and 68: Table 15: Causes of metabolic acido
Page 69 and 70: Renal HCO 3 - loss results from re
Page 71: Mixed acid-base disorders These are
Page 76 and 77: assess clinical response to fluid i
Page 78 and 79: Oliguria following surgery 48 h and
Page 80 and 81: Definition AKI is a result of a rap
Page 82 and 83: AKI is most commonly secondary to a
Page 84 and 85: History Examination Investigations
Page 86 and 87: Management Prevention Any patient a
Page 88 and 89: if no clinical response and no pulm
Page 90 and 91: acidosis pH 7.2-7.4 - there is ver
Page 92 and 93: Referral to nephrologist NOT all p
Page 94 and 95: Follow up Acute kidney injury is a
Page 96 and 97: DKA and HONK represent the two extr
Page 98 and 99: Fluids and insulin In the absence
Page 100 and 101: Surgery in the patient with diabete
Page 102 and 103: 10 mmol/l/day. In the differential
Page 104 and 105: portionately more water is lost tha
Page 106 and 107: Hypokalaemia: a fall in serum conce
Page 108 and 109: Four common aspects of Ca 2+ disord
Page 110 and 111: Treatment depends on severity and c
Page 112 and 113: 112
Page 114 and 115: Hypophosphataemia
Page 116 and 117: 116
Page 118 and 119: Prolonged periods of preoperative f
Page 120 and 121: position to postoperative parotitis
Page 122 and 123: 13. *Chowdhury AH, Lobo DN. Fluids
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42. Hussein H, Lewington A, Kanagas
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67. *Michell AR. Diuresis and diarr
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94. *Stewart PA. Modern quantitativ
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colloids 7, 26, 41, 42, 43 44, 45,
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intravascular compartment 20, 41, 4
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Stewart approach 63, 71 sympathetic
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electrolyte Therapy

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