{"id":3521,"date":"2019-11-28T14:09:29","date_gmt":"2019-11-28T14:09:29","guid":{"rendered":"http:\/\/edren.org\/ren\/education\/textbook\/fluid-therapy\/fluid-case-1\/"},"modified":"2019-12-20T15:52:54","modified_gmt":"2019-12-20T15:52:54","slug":"fluid-case-1","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/fluid-case-1\/","title":{"rendered":"Fluid case 1"},"content":{"rendered":"<p>Use the principles described in <a href=\"http:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/\">Fluids basics<\/a> to approach this problem logically. Go back to those pages to look things up when necessary.<\/p>\n<p><span style=\"color: #993300;\">A 62 year old man is 2 days post-colectomy. He is euvolaemic, and is allowed to drink 500ml. His urine output is 63 ml\/hour.<\/span><\/p>\n<hr \/>\n<p><strong><span style=\"color: #993300;\">Questions:<\/span><\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 100%; background-color: #e6f7ed;\">1. How much IV fluid does he need today?<\/p>\n<p>2. What type of IV fluid does he need? (How much of each)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"color: #993300;\"><strong><span style=\"color: #993300;\">10 marks available.<\/span><\/strong> Certainly read the hints, but write down your answer before clicking to read ours.<\/span><\/p>\n<p><strong><span style=\"color: #993300;\"><span style=\"font-family: georgia, palatino, serif;\"><span style=\"color: #993300;\">Hints:<\/span><\/span><\/span><\/strong><\/p>\n<div class=\"su-accordion su-u-trim\">\n<div class=\"su-spoiler su-spoiler-style-default su-spoiler-icon-plus su-spoiler-closed\" data-scroll-offset=\"0\" data-anchor-in-url=\"no\"><div class=\"su-spoiler-title\" tabindex=\"0\" role=\"button\"><span class=\"su-spoiler-icon\"><\/span>How to approach the first part of the question (click to expand\/collapse)<\/div><div class=\"su-spoiler-content su-u-clearfix su-u-trim\">\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 100%; background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">1. Add up the losses<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Are they beyond the normal daily assumption of 30 mls\/kg\/day?<\/li>\n<li>(When you need\/want to do a more detailed calculation, Have you included insensible losses? And a reasonable urine output &#8211; 1-2 L\/day?)<\/li>\n<li>Are there any additional losses? (e.g. drains, etc)<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">2. Add up the gains (inputs)<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Oral<\/li>\n<li>Other? (nasogastric feed &#8230;..)<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">3. <\/span><\/strong>If there is a difference, you need to prescribe that amount of supplementary\u00a0fluids &#8211; orally if possible; otherwise IV. Under the three headings of maintenance, replacement, resuscitation, which is relevant here?<\/p>\n<p><strong><span style=\"color: #993300;\">4.<\/span> <\/strong>If the patient has an existing fluid deficit or excess, you need to include that in your prescription.<\/p>\n<ul style=\"list-style-type: disc;\">\n<li>You were told that this patient is euvolaemic &#8211; i.e. &#8216;just right&#8217; for fluids<\/li>\n<li>He also has a reasonable urine output of &#8230;.. per day<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">5. <\/span><\/strong><i>Now go back to the question and decide how much fluid to give.<\/i><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div><\/div>\n<div class=\"su-spoiler su-spoiler-style-default su-spoiler-icon-plus su-spoiler-closed\" data-scroll-offset=\"0\" data-anchor-in-url=\"no\"><div class=\"su-spoiler-title\" tabindex=\"0\" role=\"button\"><span class=\"su-spoiler-icon\"><\/span>How to approach the second part of the question (click to expand\/collapse)<\/div><div class=\"su-spoiler-content su-u-clearfix su-u-trim\">\n<div align=\"left\">\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 100%; background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">1. How much sodium does the patient require?<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>What is the normal daily requirement?<\/li>\n<li>How much sodium-containing fluid is required to provide that? <a href=\"http:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/\">(revise this here<\/a>, or <a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/fluid-therapy\/\">see it in the prescribing guidelines here<\/a>)<\/li>\n<li>Is his requirement different? (does he have an increased sodium loss?)<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">2. How much potassium does the patient require?<\/span><\/strong><\/p>\n<div align=\"left\">\n<ul style=\"list-style-type: disc;\">\n<li>What is the normal daily requirement? <a href=\"http:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/\">(revise this here<\/a>, or <a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/fluid-therapy\/\">see it in the prescribing guidelines here<\/a>)<\/li>\n<li>How should you prescribe that? (we haven&#8217;t told you this yet, you&#8217;re about to find out. Or read it in advance in the prescribing guidelines at <a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/fluid-therapy\/\">bit.ly\/fluidtherapy<\/a>. Concentrate on the amount for now.)<\/li>\n<\/ul>\n<\/div>\n<p><strong><span style=\"color: #993300;\">3. Give the rest of the fluid as isotonic glucose.<\/span> <\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Ready-mixed bags of isotonic 4% glucose plus 0.18% NaCl (sodium chloride)\u00a0are available in many hospitals, and appropriate if used only as maintenance fluid (indicative 30 ml\/kg\/d; never more than 100ml\/h, <a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/fluid-therapy\/\">further info<\/a>).<\/li>\n<li>You can also deliver the fluid as separate bags of 5% glucose and sodium-containing bags.<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">4. <\/span><\/strong><i>Now go back to the question and decide how much of each fluid to give, and how much potassium.<\/i><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Use the principles described in Fluids basics to approach this problem logically. Go back to those pages to look things up when necessary. A 62 year old man is 2 days post-colectomy. He is euvolaemic, and is allowed to drink 500ml. His urine output is 63 ml\/hour. Questions: 1. How\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/fluid-case-1\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3449,"menu_order":96,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-3521","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3521","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=3521"}],"version-history":[{"count":15,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3521\/revisions"}],"predecessor-version":[{"id":3836,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3521\/revisions\/3836"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3449"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=3521"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}