1. Fluids Dr Omar Mansour Consultant Colorectal & Laparoscopic
General Surgeon
Assistant Professor of General Surgery
Al-Balqa Applied University
FRCS FRCSI FEBC MSc MRCSI

4. Existing fluid or electrolyte deficits/excesses
Patients with existing fluid or electrolyte abnormalities require a more tailored approach to fluid prescribing (see basic examples below):
Dehydration  – will require more fluid than routine maintenance
Fluid overload – will require less fluid than routine maintenance 
Hyperkalaemia – will require less potassium 
Hypokalaemia – will require more potassium

5. Principles & protocols for intravenous fluid therapy  When prescribing IV fluids remember the 5 Rs:
Resuscitation,
Routine maintenance,
Replacement,
Redistribution,
Reassessment 

6. Offer fluid therapy as part of a protocol – use the algorithms for IV fluid therapy 
Patients should have an IV fluid management plan detailing the fluid & electrolyte prescription for the next 24 hours and the assessment & monitoring plan

8. Initial assessment The initial assessment involves assessing
the patient’s likely fluid and electrolyte needs from their
history, clinical examination and available clinical monitoring (e.g. vital signs, fluid balance). 
Your clinical examination and review of available clinical monitoring should be performed using the ABCDE approach, with a focus on the patient’s fluid status.

9. History Fluid intake – has this been reduced? Thirst Dizziness/syncope
Abnormal fluid loss:
Vomiting (or NG tube loss)
Diarrhoea (including stoma output)
Polyuria
Fever
Hyperventilation
↑ drain output – e.g. biliary drain/pancreatic drain
 Co-morbidities – e.g. heart failure/renal failure

10. HISTORY SUGGESTIVE OF HYPOVOLAEMIA
Reduced fluid intake
Increased fluid losses – e.g. diarrhoea, vomiting, polyuria
Syncope/dizziness 
Thirst

12. It is a…

15. Clinical examination and review of clinical monitoring
Airway – is the airway patent?
Breathing:
Respiratory rate and oxygen saturations
Auscultate the lung fields

16. FINDINGS SUGGESTIVE OF HYPERVOLAEMIA INCLUDE:
Increased respiratory rate – >20 breaths per minute
Decreased oxygen saturations
Bilateral crackles on auscultation

17. Circulation: Pulse and blood pressure Capillary refill time
Jugular venous pressure (JVP)
Peripheral oedema

18. FINDINGS SUGGESTIVE OF HYPOVOLAEMIA INCLUDE:
Increased heart rate – >90 bpm
Hypotension – systolic BP <100 mmHg
Prolonged capillary refill time
Non-visible JVP

23. FINDINGS SUGGESTIVE OF HYPERVOLAEMIA INCLUDE:
Hypertension
Elevated JVP 

27. GCS FINDINGS SUGGESTIVE OF HYPOVOLAEMIA INCLUDE
Decreased GCS may be noted if the patient is significantly volume depleted.
What is GCS

28. GCS

29. Exposure: Wounds Drains Catheter output
Abdominal distension/peripheral oedema
Fluid balance charts/weight charts
Other losses – e.g. rectal bleeding

35. Fluids Management in Burns Patients