03_04_05 Fluid therapy

Fluid Therapy
Session Overview
Description
This session describes a rational approach to the use of intravenous fluids in critical care based on a modern understanding of the physiology of fluid homeostasis, and on the available evidence in this area.

Learning Objectives
By the end of this session you will be able to:

• List the indications for intravenous fluids in critical care
• Describe how the distribution of water and electrolytes in the body is maintained
• Compare available intravenous fluids in terms of composition, cost, and adverse effects
• Explain the principles of prescribing maintenance fluids in the postoperative or critically-ill patient
• Explain the rationale for and limitations of using fluid to support the circulation in shock
• Outline how abnormal fluid and electrolyte losses may be appropriately replaced

Prerequisites
Before commencing this session you should complete:

• Overview of Intravenous Fluids (001-0222)

Intravenous fluids are among the most commonly prescribed medications in hospital, and yet studies repeatedly show that a minority of doctors have the knowledge required to safely do so [1](read details regarding the reference),[2](read details regarding the reference). As a result, up to 1 in 5 patients receiving intravenous fluids may suffer complications from their inappropriate use [3](read details regarding the reference).

In critical care, patients are even more susceptible to these complications, and appropriate management of fluid and electrolyte status is often key to resolving the organ failures that make a patient dependent on critical care.

Intravenous fluid therapy is acknowledged to be a complex therapy which needs to be tailored to each patient and their clinical context; you cannot simply pick a dose from a table. It is also an area of controversy, and opinion varies even among world experts. However, a structured approach, backed up by some physiology and evidence, can give you the confidence that your fluid prescribing is rational and safe.