{"id":3525,"date":"2019-11-28T14:10:15","date_gmt":"2019-11-28T14:10:15","guid":{"rendered":"http:\/\/edren.org\/ren\/education\/textbook\/fluid-therapy\/fluid-case-3\/"},"modified":"2019-12-20T15:52:13","modified_gmt":"2019-12-20T15:52:13","slug":"fluid-case-3","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/fluid-case-3\/","title":{"rendered":"Fluid case 3"},"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<hr \/>\n<p><span style=\"color: #993300;\">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.<\/span><\/p>\n<p><strong><span style=\"color: #993300;\">Questions:<\/span><\/strong><\/p>\n<table>\n<tbody>\n<tr>\n<td style=\"background-color: #e6f7ed;\"><span style=\"font-family: georgia, palatino, serif; font-size: 14pt;\">1. How much fluid has he accumulated during the last 3 days?<\/span><\/p>\n<p><span style=\"font-family: georgia, palatino, serif; font-size: 14pt;\">2. What would you do with his IV fluids?<\/span><\/p>\n<p><span style=\"font-family: georgia, palatino, serif; font-size: 14pt;\">3. Do you have any comments about the probable state of his fluid balance 3 days ago?<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><em><strong>10 marks available.<\/strong> Read the hint if you like &#8230; maybe you don&#8217;t need it this time.<\/em><\/p>\n<p><strong><span style=\"color: #993300;\">Hints:<\/span><\/strong><\/p>\n<div id=\"q2\" class=\"answer\">\n<div align=\"left\">\n<div id=\"q5\" class=\"answer\">\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>Just one hint this time. (click to expand\/collapse)<\/div><div class=\"su-spoiler-content su-u-clearfix su-u-trim\">\n<table>\n<tbody>\n<tr>\n<td style=\"background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">1. Add up the fluid balance over the last 3 days<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Have you included insensible losses?<\/li>\n<li>Are there any additional losses or gains to consider?<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">3. Consider the clinical picture<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Compare the amount of excess fluid you have calculated. Do you think he was euvolaemic 3 days before?<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">4.<\/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 id=\"q2\" class=\"answer\">\n<\/div><\/div>\n<p><strong><span style=\"color: #993300;\">Answer:<\/span><\/strong><\/p>\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>When you have written down your answer - click here to reveal ours <\/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;\">\n<div align=\"left\">\n<div id=\"q6\" class=\"answer\">\n<div align=\"left\">\n<div id=\"q9\" class=\"answer\">\n<p><strong><span style=\"color: #993300;\">1. Fluid balance<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>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.<\/li>\n<\/ul>\n<p><span style=\"color: #993300;\">Indicative marking scheme: 4 marks for 1.25-1.75 litres. 2 marks for 1.8-3.0 litres.<\/span><\/p>\n<p><strong><span style=\"color: #993300;\">2. What should you do with his IV fluids?<\/span><\/strong><\/p>\n<div align=\"left\">\n<ul style=\"list-style-type: disc;\">\n<li>Stop them.<\/li>\n<\/ul>\n<p><span style=\"color: #993300;\">Indicative marking scheme: 4 marks for this answer. 500mls or less: 2 marks.<\/span><\/p>\n<\/div>\n<p><strong><span style=\"color: #993300;\">3. His fluid balance 3 days ago<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>The clinical picture suggests that substantially more than 1.5 litres of extra fluid has accumulated.<\/li>\n<li>The patient must have started out with significant excess extracellular fluid 3 days ago.<\/li>\n<li>So one day of fluid restriction would not be enough, probably<\/li>\n<\/ul>\n<p><span style=\"color: #993300;\">Indicative marking scheme: 2 marks for identifying pre-existing fluid excess.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div align=\"left\">\n<div id=\"q6\" class=\"answer\">\n<div align=\"left\">\n<div align=\"left\">\n<table>\n<tbody>\n<tr>\n<td style=\"background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">Maximum marks for this question 10; pass mark 5<\/span><br \/>\n<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/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. 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\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/fluid-case-3\/\"><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-3525","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3525","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=3525"}],"version-history":[{"count":12,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3525\/revisions"}],"predecessor-version":[{"id":3838,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3525\/revisions\/3838"}],"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=3525"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}