Makindo Medical Notes

💧 Always individualise fluid assessment. Use postural BP, HR, JVP, thirst, oedema, mucous membranes, skin turgor, and fluid balance chart. Think dynamically: are they underfilled (need resuscitation) or overfilled (risk of harm if more fluid given)?

📌 About

• Use an ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure).
• Assess whether the patient is hypovolaemic and needs fluid resuscitation.
• Examine volume status in the context of trends, clinical exam, and investigations.

⬇️ Indicators Suggesting Underfilled (May Need Fluids)

• Weak/low volume pulse
• JVP low / collapsed neck veins
• SBP < 100 mmHg
• HR > 90 bpm
• Capillary refill > 2s
• Cool peripheries
• Postural drop in BP
• RR > 20 breaths/min
• NEWS ≥ 5
• CXR: no pulmonary oedema
• Weight loss due to fluid deficit
• 45° passive leg raise → positive fluid responsiveness

⬆️ Indicators Suggesting Overfilled (Avoid Fluids)

• Raised JVP / high CVP
• Hypertension
• Bounding pulse
• Basal crackles
• Tachycardia
• Peripheral oedema
• Ascites
• Pulmonary oedema on CXR
• Weight gain

⚠️ Cautions

• Be cautious in frail/elderly — avoid overloading.
• If possible, use oral hydration over IV.
• In acute stroke, avoid excess IV dextrose (worsens cerebral oedema risk).
• Think twice before giving 3 L/day to a frail elderly patient — may precipitate pulmonary oedema.

💉 Fluid Challenge

• Give a 250 ml bolus of 0.9% saline, then reassess.
• If physiology improves → may need further IV fluids.

🧪 NICE: Maintenance IV Fluids

• Water: 25–30 ml/kg/day
• Electrolytes: 1 mmol/kg/day (Na, K, Cl)
• Glucose: 50–100 g/day (e.g. 1 L of 5% dextrose ≈ 50 g)

📊 Typical Daily Regimen (70 kg adult, normal function)

• 1 L 0.9% NaCl + 20 mmol KCl
• 1 L 5% Dextrose + 20 mmol KCl
• 1 L 5% Dextrose + 20 mmol KCl

👵 Frail / Low Weight Patients

• 1 L 0.9% NaCl + 20 mmol KCl
• 1 L 5% Dextrose + 20 mmol KCl

🔄 Reassessment & Monitoring

• Post-op patients have high ADH → risk of hyponatraemia, avoid excess dextrose.
• Fluid balance may require adjusting (e.g. 2:1 ratio saline:dextrose if low Na⁺).
• Replacement fluids for drains/NG/gastro losses → usually 0.9% saline.
• Always consider cardiac/renal function when prescribing fluids.
• Stop IV fluids when no longer required — switch to enteral if >3 days.