*Use the principles described in **
Fluids basics **to approach this problem logically. Go back to those pages to look things up when necessary.*

An 85 year old man receives IV fluids for 3 days following a stroke; he is not allowed to eat. He has ankle oedema and a JVP of +5 cms; his charts reveal a total input of 9 litres and a urine output of 6 litres over these 3 days. Questions:

1. How much fluid has he accumulated during the last 3 days?

2. What would you do with his IV fluids?

3. Do you have any comments about the probable state of his fluid balance 3 days ago?

10 marks available. Read the hint if you like ... maybe you don't need it this time.

Hints

A simple question again?

**1. Add up the fluid balance over the last 3 days**

- Have you included insensible losses?
- Are there any additional losses or gains to consider?

**3. Consider the clinical picture**

- Compare the amount of excess fluid you have calculated. Do you think he was euvolaemic 3 days before?

**4. ***Now go back to the question and decide how much fluid to give.*

Answer

**1. Fluid balance**

- He has put out 2 litres of urine each day, and had an additional 0.5 litres of insensible loss daily. He has received 3 litres of IV fluids daily. So he has accumulated 1.5 litres of excess fluid.

Indicative marking scheme: 4 marks for 1.25-1.75 litres. 2 marks for 1.8-3.0 litres.

**2. What should you do with his IV fluids?**

Indicative marking scheme: 4 marks for this answer. 500mls or less: 2 marks.

**3. His fluid balance 3 days ago**

- The clinical picture suggests that substantially more than 1.5 litres of extra fluid has accumulated.
- The patient must have started out with significant excess extracellular fluid 3 days ago.
- So one day of fluid restriction would not be enough, probably.

Indicative marking scheme: 2 marks for identifying pre-existing fluid excess.

**Maximum marks for this question 10; pass mark 5**