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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, January 14, 2014

Fluidos intravenosos

St. Emlyn´s - January 8, 2014 by Janos Baombe
"What are the recommendations?
1. IV fluid therapy is to be provided only to those patients whose needs cannot be met by oral or enteral routes. This seems obvious but we have to acknowledge that we tend to be overzealous with fluid therapy in clinical situations where often a pint of fluid is enough.
2. Prescribing staff need to remember the five Rs: resuscitation, routine maintenance, replacement, redistribution and reassessment. This should be seen as a treatment continuum with each stage having its particularity on fluid type, volume, rate etc.
3. An algorithm is offered to facilitate administration of fluid therapy. Algorithm 1 and 2 are probably the most relevant to Emergency Medicine (assess needs and fluid resuscitation)
4. The guidance further stresses that the type of fluid and rate/volume is to be specified. Now, I am quite bad at this often just scribbling down NaCl STAT (instead of Normal Saline Solution 0.9% at 500ml/h).
5. IV fluid management is to review over the next 24 hours and on a daily basis. This again sounds obvious but there is a need to adjust type, volume and rate according to responsiveness and electrolytes.
6. Take into account all other sources of fluid and electrolytes intake including drugs, IV nutrition, blood and blood products. And yes, it does include that 250ml of Dextrose in which you had given vitamin B complex or the IV paracetamol. Again, I am bad at this!
7. Involve the patient whenever possible in decision making and discuss signs and symptoms to look out for if need is to adjust their balance. I guess, it is a medial intervention so it would be part of the GMC document Good Medical Practice."