FLUID MANAGEMENT

Specific conditions

If patient has any of the following conditions, follow appropriate condition-specific guideline

Medical guidelines

• Diabetic ketoacidosis
• Hyperosmolar hyperglycaemic state
• Acute adrenal insufficiency
• Acute upper gastrointestinal haemorrhage
• Hypo/hypernatraemia
• Acute cardiac failure
• Acute liver failure
• Acute kidney injury (acute renal failure)
• Hypercalcaemia

Surgical Guidelines

• Diabetes mellitus and requirement for fluids to cover surgery
• Post-operative haemorrhage
• Recent retention of urine

Initial assessment

History

• Intake/absorption, thirst, abnormal losses, comorbidities
• Check NEWS, fluid balance charts, weight

Examination

• Mental status, skin turgor, are eyes sunken?
• Respiratory rate, pulse, capillary refill, JVP when supine, peripheral or pulmonary oedema, BP (postural hypotension?), urine output
• Assess fluid deficit

Investigations

• FBC, U&E, glucose, ESR
• If blood loss suspected, group and save or crossmatch
• If peripheral perfusion is poor, arterial/venous blood gases or lactate to detect metabolic acidosis, CRP, coagulation studies

• Use ABCDE approach and address cause of any fluid deficit
• Assess volaemic status and venous pressure

Fluid deficit

• Go to Fluid Resuscitation guideline

No fluid deficit

• If the patient is able to ingest and absorb normal fluid load and not nil-by mouth, encourage patient to drink and/or give patient fluids enterally – see Practice and ethics of nutritional support in medical patients guideline especially if any complex fluid or electrolyte problems
• If the patient is unable to ingest and absorb normal fluid load or is nil-by mouth, go to IV MAINTENANCE FLUIDS guideline