Basic Concepts of Fluid and Electrolyte Therapy

assess clinical response to fluid in terms of
capillary refill time
pulse (reduction in pulse if tachycardic)
jugular venous pressure (rise in JVP)
blood pressure (rise in BP)
pulmonary oedema (if present stop iv fluid)
urine output
if there is a clinical response to fluid bolus continue with replacement
fluids and discuss further fluid therapy management plan
with senior member of team.
if there is no clinical response and no pulmonary oedema administer
further 500 ml of crystalloid, reassess clinically and discuss
with senior member of team. Remember to consider postoperative
bleeding as a cause for the hypovolaemia and failure to respond to
a fluid challenge.
if the patient has volume unresponsive oliguric AKI continue with
iv fluids cautiously, matching urine output and monitoring for
signs of respiratory distress (rising respiratory rate, pulmonary
oedema or falling oxygen saturations). Refer to the renal team.
Oliguric AKI secondary to hypovolaemia is either volume responsive or
unresponsive. In some cases, despite apparently adequate intravascular
volume replacement the patient remains oliguric and unresponsive
to any further fluid challenge. At this point, to avoid precipitating pulmonary
oedema, no further intravenous fluid should be administered
and the patient should be referred to the renal team. In patients who
are fluid responsive, further fluid replacement can be prescribed as
hourly fluid input equal to the previous hour’s output plus 30 ml, with
continuous monitoring and frequent review.
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