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Fluid case 3

Use the principles described in Fluids basics to approach this problem logically. Go back to those pages to look things up when necessary.


An 85 year old man receives IV fluids for 3 days following a stroke; he is not allowed to eat. He has ankle oedema and a JVP of +5 cms; his charts reveal a total input of 9 litres and a urine output of 6 litres over these 3 days.

Questions:

1. How much fluid has he accumulated during the last 3 days?

2. What would you do with his IV fluids?

3. Do you have any comments about the probable state of his fluid balance 3 days ago?

10 marks available. Read the hint if you like … maybe you don’t need it this time.

Hints:


Just one hint this time. (click to expand/collapse)

1. Add up the fluid balance over the last 3 days

  • Have you included insensible losses?
  • Are there any additional losses or gains to consider?

3. Consider the clinical picture

  • Compare the amount of excess fluid you have calculated. Do you think he was euvolaemic 3 days before?

4. Now go back to the question and decide how much fluid to give.

Answer:

When you have written down your answer - click here to reveal ours

1. Fluid balance

  • He has put out 2 litres of urine each day, and had an additional 0.5 litres of insensible loss daily. He has received 3 litres of IV fluids daily. So he has accumulated 1.5 litres of excess fluid.

Indicative marking scheme: 4 marks for 1.25-1.75 litres. 2 marks for 1.8-3.0 litres.

2. What should you do with his IV fluids?

  • Stop them.

Indicative marking scheme: 4 marks for this answer. 500mls or less: 2 marks.

3. His fluid balance 3 days ago

  • The clinical picture suggests that substantially more than 1.5 litres of extra fluid has accumulated.
  • The patient must have started out with significant excess extracellular fluid 3 days ago.
  • So one day of fluid restriction would not be enough, probably

Indicative marking scheme: 2 marks for identifying pre-existing fluid excess.

Maximum marks for this question 10; pass mark 5