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Ebook Making sense of fluids and electrolytes: Part 2

Part 2 book “Making sense of fluids and electrolytes” has contents: Intravenous fluid therapy in medical patients, fluid therapy management in surgical patients, blood products and transfusion. Invite to references. | Chapter 4 Intravenous fluid therapy in medical patients INTRODUCTION The optimal fluid management of medical patients is of great importance and is often poorly managed. The role of the physician in accurately assessing fluid status, losses and requirements is critical. Medical patients can present with multiple co-morbidities that make fluid management challenging, for example the septic patient with congestive cardiac failure (CCF). Medical wards cannot provide the invasive monitoring and high staff to patient ratios that are found in an intensive therapy unit/high dependency unit (ITU/HDU) environment and some patients may not be appropriate for escalation to these levels of care. This means that good clinical fluid assessment, scrupulous fluid balance monitoring, and sound clinical judgement and knowledge are required by all junior doctors working on medical wards. Decisions regarding intravenous fluid (IVF) therapy are often far from routine – do not hesitate to seek senior or specialist advice, for which this chapter is no substitute. 73 74 Making Sense of Fluids and Electrolytes REMEMBER Maintenance fluids in medical patients ‘Doctor, could you just come up to the ward to write up some fluids?’ Prescribing maintenance intravenous fluids should not be considered a robotic or routine task; it is the same as prescribing medication. Careful assessment of fluid status and exacting fluid prescription is of paramount importance, as is checking the patient’s most recent blood results. When asked to prescribe maintenance fluids always consider the reason for IVF therapy (is it still necessary?). Check: • • • Patient fluid status Electrolyte requirements, recent U+Es Any special considerations from their medical history Aim to encourage oral intake as much as possible. MEDICAL CONSIDERATIONS IN FLUID ASSESSMENT AND MANAGEMENT To cover both urine output and insensible losses, healthy adults require around 30–40 mL/kg of water over 24 hours. This equates to .