Critical care education one page at a time. Simple, free, & open source.
Nick Mark’s OnePager guides to critical care topics.
Achieving a Negative Fluid Balance
#criticalCare #nephrology #fluids #diuresis #RRT
Volume overload is very common in the later stages of critical illness, and achieving a negative fluid balance is key to helping patients liberate from mechanical ventilation and ultimately recover. I outline strategies for minimizing ins (avoid MIVF, use high concentration drips, switch IV to PO) and maximizing outs (stepwise diuresis with loop diuretics, thiazides, spironolactone, and acetazolamide). I also discuss special circumstances including cirrhosis, nephrotic syndrome, and hypoalbuminemia.
Current version 1.4 (originally posted 2020-10-21; updated 2020-10-23) Also available in 🇫🇷 French (PDF)
-
Fluid Overload and Mortality in Adult Critical Care Patients-A Systematic Review and Meta-Analysis of Observational Studies, Crit Care Med 2020
Medication Use as a Contributor to Fluid Overload in the PICU: A Prospective Observational Study, Journal of Pediatric Intensive Care 2018
Delayed Nephrology Consultation and High Mortality on Acute Kidney Injury: A Meta-Analysis, Blood Purification 2017
-
-
Also available in
🇫🇷 French (PDF)
-
Current version 1.4
originally posted 2020-10-21
updated 2020-10-23
-
Intravenous to Oral Switch Therapy, Medscape 2018