Basic Concepts of Fluid and Electrolyte Therapy

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Referral to nephrologist NOT all patients diagnosed with AKI need to be referred Prior to referral the following should be performed a thorough clinical history and examination (including fluid balance/volume status assessment) initial investigations (as recommended above) initial supportive management (as recommended above) Early renal referral is recommended in the following patients AKI stage 3 (SCr ≥3 × baseline value) (Table 19) persistent oliguria and/or rising serum creatinine despite supportive therapy complications refractory to medical treatment hyperkalaemia (K >6 mmo/l) pulmonary oedema acidosis (pH
Recovery The first signs of recovery from oliguric AKI may be an increase in urine output. Alternatively recovery may be heralded by a reduction in the rise in the daily serum creatinine followed by a plateau in its value prior to a fall. Recovery from AKI can result in a polyuric state in some patients with the production of large urine volumes until the capacity of the renal tubule to concentrate urine returns. There must therefore be careful attention to the patient’s volume status and fluid requirements. Patients can be at risk of developing a free water deficit which manifests as hypernatraemia and requires an increased intake of water (intravenous 5% dextrose if unable to take water orally). Failure to address the free water deficit promptly will not only slow renal recovery but will also put the patient at risk of neurological complications. Another potential complication is the development of hypokalaemia, which requires appropriate therapy due to the risk of cardiac arrythmias and ileus. A balanced crystalloid containing potassium is recommended in this clinical context. If further potassium is required consider infusing dextrose saline (4%/0.18%) with added potassium 93
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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 90 and 91: acidosis pH 7.2-7.4 - there is ver
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
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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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