The best post operative iv. fluid for maintenance of a 70Kg man with no other comorbidities is:
Dextrose water 5%, at 80ml/hr with 20mmol/L of KCl.
Sodium Chloride 0.9%, at 125ml/hr.with 20 mmol/L of KCl.
Dextrose 5%, 0.45% Saline, at 125ml/hr. with 20mmol/L of KCl
Human Albumin 5%, 125ml/hr.
The simple approach to a daily dilemma that faces so many clinicians!. The art is to handle the ambiguous cases with abundance of caution as getting it wrong can cause serious consequences.
Mini fluid challenge is to give 100ml of iv fluid and monitor the effect on Cardiac output which can be transient. (Ideally a continuous CO monitoring device must be attached to the patient).
Select the type of shock for the hemodynamic profile
0%Cardiogenic shock
0%Hypovolemic shock
0%Distributive shock
0%Neurogenic shock
Low SVRI High CI PR 119 Vasodilatory and Hyperdynamic heart. so not cardiac or hypovolemic Tachycardic so not neurogenic All goes with distributive shock.
IVC use in spontaneously breathing patients (IVC collapsibility index) can be of value in identifying patients who might respond to fluid administration. (From our Hemdynamic for the intensivist course).
Creator
Excellent for choosing Dextrose half saline as this will ensure adequate fluid volume, in addition to adequate glucose to prevent ketosis and at the same time avoid giving high sodium containing fluids which may lead to worse fluid retention due to the expected excessive excretion of ADH after surgical procedures due to pain and commonly occuring hypovolemia.