IV FLUIDS

CLINICAL SCENARIO

A 35 year old Caucasian female presents to hospital with a 5 day history of diarrhoea and vomiting secondary to gastroenteritis.

Open Question

You have been asked to prescribe her fluids. How will you assess her fluid status?

Open Question

What are the other areas you may want to take into account when prescribing fluids for a patient?

Open Question

Clinically, she looks very dehydrated-dry mucous membranes, pale and has cold peripheries. Her blood pressure is 106/64.

Her blood results come back as follow:-


Sodium 130 mnol/L (normal range 135 to 145 mmol/L)

Potassium 2.8 mmol/L (normal range 3.5 to 5.1 mmol/L)

Chloride 93 mmol/L (normal range 98 to 106mmol/L)

Urea 8.2 (normal range 2.5-6.4 mmoL/L)

Creatinine  126 (normal range 62-106 μm/L)


Suggest a fluid regimen for her.

Teacher's Comment

When unsure if a patient is hypovolaemic, you can give a bolus infusion of 200ml of colloid/crystalloid. Assess the patient clinically before and 15 minutes after the bolus, until there is no further improvement in the clinical parameters.