Fluid Balance

Question 1

What are the signs of hypovolaemia?

Answer 1

Decreased BP, reduced urine volume, non-visible JVP, poor tissue turgor, increased pulse, daily weight loss

Question 2

What are the signs of fluid overload?

Answer 2

Increased BP, increased JVP, lung creps, peripheral oedema, gallop rhythm (S3 gallop)

Question 3

How is hypovolaemia managed?

Answer 3

1) 500mL Crystalloid over 15 mins
2) Reassess fluid state
3) Further boluses of 250-500mL crystalloid, with clinical review after each
4) Stop when euvolaemic or seek expert help when 2L given

Question 4

What crystalloids can be used?

Answer 4

Follow local guideline

Usually, balanced or buffered crystalloids include Hartmann’s, Ringer’s lactate, and Plasma-Lyte®

Question 5

How is hypervolaemia managed?

Answer 5

1) O2 supplementation if required
2) Fluid restriction
3) Diuretics - if symptomatic
4) RRT - AKI + oligo/anuria

Question 6

What is the routine maintenance of IV fluids?

Answer 6

• 25-30 ml/kg/day water + 500ml for insatiable losses
• 1mmol/kg/day Na+, K+, Cl-
• 50-100g/day glucose (e.g. glucose 5% contains 5g/100ml

Question 7

How much K+ can be given?

Answer 7

No more than 10mmol/hr due to effects on heart