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Fluid case 4

Educational resources for renal medicine

Licensed under a Creative Commons LicenseCreative Commons Attribution 4.0 International License.

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

A complicated case. But exactly the same principles apply.

5 days after a liver transplant, a 48 year old man has a pyrexia of 40.8 degrees C. His charts for the last 24 hours reveal:

urine output:
drain output:
nasogastric output:
blood transfusion:
IV crystalloids:
oral fluids:
2.7 litres
525 ml
1.475 litres
2 units (350 ml each)
2.5 litres
500 ml

On examination he has a tachycardia. His supine BP is OK, but you can’t sit him up to check his erect BP. His serum [Na+] is 140 mmol/l. Questions:

  1. How much IV fluid is he likely to need over the next 24h, assuming these outputs remain the same? (it is of course unlikely that they will be quite the same)
  2. What fluids would you use?
How to approach the first part of the question (click to expand/collapse)

How to approach the second part of the question (click to expand/collapse)

Click to reveal our answer. 

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Page last modified 20.09.2014, 17:52 by Administrator. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.