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1. FLUID CHALLENGE Mimi, Connie and Pat
2. WHAT IS FLUID CHALLENGE Fluid challenge is a diagnostic procedure used to identify a hypovolaemic condition. If hypovolaemia is the cause for a patients hypotension, rapidly administering fluids should result in a change of the patients condition indicating the need for further fluid resuscitation.
3. Contd Fluid challenges require the definition of four components:
The type of fluid to be administered (e.g. natural or artificial colloids, crystalloids).
The rate of fluid infusion (e.g., 500-1000ml over 30mins).
The end points (e.g., mean arterial pressure of > 70mm Hg, heart rate of < 110 beats/min).
The safety limits (e.g. development of pulmonary oedema).
4. Why Fluid challenge is given? Crystalloids or colloids can be harmful if administered in insufficient or excessive amount. If fluid loss is under corrected, patient will develop hypovolaemia which may lead to renal impairment and other complications. Over correction can lead to pulmonary oedema. Fluid challenge allows prompt correction of fluid deficits reducing risk of fluid overload or under correction.
5. Contd Gradual hypovolaemia can cause hypotension. Fluid challenge can be needed to determine if the reduced urinary output is due to hypovolaemia. If hypovolaemia is confirmed, appropriate correction is effected.
6. Types Of Fluids Used There are two types of fluids that are used for intravenous drips, these are Crystalloids and Colliods.
Crystalloids are substances that form a true solution and pass freely through a semipermeable membrane. They contain water and electrolytes and stay in the intravascular compartment for a shoter time than colloids.
Normal Saline, Dextrose 5%, Hartmans Solution (Sodium lactate) are Crystalloids.
Crystalloids are useful in maintain fluid balance for example, postoperatively when a patient is not drinking- or in conjunction with colloid to replace intravascular volume rapidly after sudden blood loss.
7. Contd Crystalloids are useful in maintain fluid balance for example, postoperatively when a patient is not drinking- or in conjunction with colloid to replace intravascular volume rapidly after sudden blood loss.
Colliods are substances that do not dissolve into a true solution and do not pass through a semipermeable membrane. Colliod solutions tend to stay in the intravascular compartment for longer than crystalloids, and therefore less volume is needed. Dextrans, Gelatines, and Hydroxyethyl starches are example of Colliods.
8. Reference List Fluid challenge (online), Available from www.sprtanburgens.com/protocol accessed on 03|11|2006.
Fluid challenge revisted (online), Available from www.ncbI.nlm.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 accessed on 03|11|2006.
Webb, A.N. (2000) Critical care. Vol. 4 (supplementary 2): P 26-32.
Shami, S and Derbon, T. (1997) UnderStanding Fluid Balance. British Medical Journal. LMS