Basic Concepts of Fluid and Electrolyte Therapy

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acidosis pH 7.2-7.4 – there is very little evidence to support correction with bicarbonate. pH 95 mmHg. iv furosemide can be tried if the patient is haemodynamically stable and adequately intravascularly filled. The dose is dependent on the severity of AKI. Furosemide 160 mg (slow infusion over 1 hour) may be required for severe AKI (stage 3) (Table 19). renal replacement therapy if the patient is in extremis ± being ventilated 90
uraemic encephalopathy renal replacement therapy uraemic pericarditis renal replacement therapy Medication management In patients with AKI it is important to identify medications that are normally metabolised and/or excreted by the kidneys, and either avoid or make appropriate dose adjustments. Common examples include: penicillins cephalosporins vancomycin morphine (metabolites will accumulate) low molecular weight heparin If the patient is hypotensive there should be a low threshold for withholding antihypertensive therapy which will only exacerbate renal hypoperfusion. Common examples include: angiotensin-converting enzyme inhibitors angiotensin receptor blockers diuretics Nephrotoxic medications should be avoided if possible (unless lifesaving) and include: non-steroidal anti-inflammatory drugs (NSAIDs) gentamicin amphotericin 91
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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
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Intravascular fluid volume - the to
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Colloid - a fluid consisting of mic
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Base excess - Base excess is define
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Parameter Urine output Significance
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Figure 5: Example of a vital signs
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Fluid balance charts These provide
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Osmolality In the presence of AKI,
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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 74 and 75: Urine output should be interpreted
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 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
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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
Page 124 and 125: 42. Hussein H, Lewington A, Kanagas
Page 126 and 127: 67. *Michell AR. Diuresis and diarr
Page 128 and 129: 94. *Stewart PA. Modern quantitativ
Page 130 and 131: colloids 7, 26, 41, 42, 43 44, 45,
Page 132 and 133: intravascular compartment 20, 41, 4
Page 134 and 135: Stewart approach 63, 71 sympathetic
Page 136: Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electrolyte Therapy

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