Basic Concepts of Fluid and Electrolyte Therapy

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Follow up Acute kidney injury is a recognized antecedent for chronic kidney disease and patients require follow up. The discharge summary to primary care should summarise: the cause of AKI risk factors for AKI medications stopped and started blood pressure (longer term monitoring required) kidney function Refer patients to nephrology left with an estimated glomerular filtration rate (eGFR)
10. The Patient with Diabetes Mellitus Introduction Although, with better management of diabetes in recent years, admissions due to loss of control with or without ketosis are less frequent than in former times, nonetheless cases of decompensated diabetes with keto-acidosis (DKA) or hyperosmolar non-ketotic (HONK) syndrome form an important part of every doctor’s experience of acute medicine. Similarly, with the rising prevalence of diabetes, particularly type 2, the perioperative fluid and metabolic management of diabetic patients has become increasingly important. Decompensated Diabetes Type 1 diabetes: insulin secretion is impaired in most cases by >90%. This means that, with reduced or absent administration of insulin or with increased insulin demand due to intercurrent illness, not only does the blood glucose rise but control over fat and protein metabolism is lost, leading to keto-acidosis (-hydroxybutyrate being the main keto-acid) and protein catabolism. Type 2 diabetes: This is associated initially with insulin resistance but only partial loss of secretion. At this stage, there is sufficient circulating insulin to prevent ketosis but not to control the blood glucose. Decompensation is usually associated with HONK in which the blood glucose rises to higher levels than those seen in DKA (it only takes a fraction of the amount of insulin to control ketosis as it does to control blood glucose). With loss of insulin secretion over the years and with severe intercurrent illness type 2 diabetics can develop keto - acidosis, requiring insulin, even though they may be able to revert to tablet treatment afterwards . 95
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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
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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 92 and 93: Referral to nephrologist NOT all p
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
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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