Is there any guideline or published papers regarding the use of maintenance IV fluids in patients with fluid overload (eg. CKD or HF) who are already using diuretics to relive symptoms of pulmonary congestion??
If they have any pulmonary issues secondary to hypervolemia, fluids are not indicated. However, if you are talking about a stable CHF patient with chronic diuretic use who needs maintenance therapy for whatever reason, 5% dextrose in a solution of 0.9% saline is acceptable at modest rates amounting to the fluid restriction they have been following as outpatient (~1.5L per day).
You may want to go through this article.
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0082770/
Thank you professor Abhilash Koratala. Yes I talk about using maintenance IV fluid while patient on high dose diuretic to relive pulmonary congestion (eg. CHF or CKD), is that accurate practice?
In other words do we need maintenace IV fluid for patients with already hypervolemia?
For 'stable' patients not currently having any congestive symptoms and not able to take po, maintainence fluids are indicated at rates such as 60ml/min. It's just like the patient is on diuretics but still allowed to consume fluids as outpatient.
Here is the NICE guideline-
https://www.nice.org.uk/guidance/cg174/chapter/1-Recommendations#principles-and-protocols-for-intravenous-fluid-therapy-2
It comes down to what the patients current fluid status is and whether you are concerned about electrolyte deficits or not. If they are fluid overloaded then a decision has to be made as to exactly what is a safe amount of fluid to be taken in over the next 24 hours.
Thank you professor Abhilash Koratala and professor Deborah Jean
Maintenance fluid therapy is needed for insensible loss ( 900 ml ) from respiratory tract ( 400 ml ) & skin ( 500 ml ) & from sensible loss , such as urine output ( 1500 ml ) & fecal loss ( 100 ml ) with a total of 2500 ml .
It has been suggested that the fluid recommendation for fluid overload patient should be urine output + 500 ml . In practice , it is preferable to keep a negative balance & go by weight loss of 1/2 to 1 kg per day . This would mean that the urine output should exceed the intake . For eg , if the urine output is 1500 ml , the intake should be 500 ml only , if the patient is symptomatic . Salt restriction is needed to avoid edema & water restriction to prevent hyponatremia . Edema always means excess salt & hyponatermia means excess water & both can be combined .
I agree with all the authors comments. Inferior venacava diameter in echo or usg might help to guide fluid therapy in such conditions. Thanks...