{"id":3527,"date":"2019-11-28T14:10:39","date_gmt":"2019-11-28T14:10:39","guid":{"rendered":"http:\/\/edren.org\/ren\/education\/textbook\/fluid-therapy\/fluid-case-4\/"},"modified":"2019-12-20T15:49:38","modified_gmt":"2019-12-20T15:49:38","slug":"fluid-case-4","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/fluid-therapy\/fluid-case-4\/","title":{"rendered":"Fluid case 4"},"content":{"rendered":"

Use the principles described in Fluids basics<\/a> to approach this problem logically. Go back to those pages to look things up when necessary.<\/p>\n

\n

A complicated case. But exactly the same principles apply.<\/p>\n

5 days after a liver transplant, a 48 year old man has a pyrexia of 40.8 degrees C. His charts for the last 24 hours reveal:<\/span><\/p>\n

\n\n\n\n
urine output:
\ndrain output:
\nnasogastric output:
\nblood transfusion:
\nIV crystalloids:
\noral fluids:<\/td>\n		2.7 litres
\n525 ml
\n1.475 litres
\n2 units (350 ml each)
\n2.5 litres
\n500 ml<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

On examination he has a tachycardia. His supine BP is OK, but you can\u2019t sit him up to check his erect BP. His serum [Na+] is 140 mmol\/l.<\/span><\/p>\n

Questions:<\/span><\/strong><\/p>\n\n\n\n
\n
    \n
  1. How much IV fluid is he likely to need over the next 24h, assuming these outputs remain the same? (it is of course unlikely that they will be quite the same)<\/li>\n
  2. What fluids would you use?<\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Hints:<\/span><\/strong><\/p>\n

    \n
    \n
    \n
    \n
    <\/span>How to approach the first part of the question (click to expand\/collapse)<\/div>
    \n\n\n\n
    \n
    \n

    1. Add up the fluid balance over the last 24h<\/span><\/strong><\/p>\n