Diuresis in Critical Care - Achieving a Negative Fluid ...
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Diuresis in Critical Care - Achieving a Negative Fluid Balance

Advantages Of A Negative Fluid Balance:

 • Volume overload is very common in the later (e.g. de-escalation) phases of critical illness. Achieving a negative fluid balance is key to liberation from MV, mobility, & ultimate recovery.

 • In people with sepsis, AKI, or who are post-op, risk of mortality increased by 1.19x per liter of positive fluid balance.

MINIMIZE INs:

 • USE FLUIDS PARSIMONIOUSLY IN RESUSCTIATION

 • SWITCH IV TO PO

 • USE HIGH CONCENTRATION MEDICATIONS

 • AVOID MAINTENANCE FLUIDS

 • REMOVE UNECCESARY MEDS

MAXIMIZE OUTs:

 • Start with LOOP DIURETICS which are short acting and rapidly titrated to achieve UOP

 • Add a THIAZIDE to augment diuresis, address diuretic resistance, & to correct hyponatremia

 • Add a SPIRONOLACTONE (or ENaC INHIBITOR) to normalize Potassium homeostasis especially in high aldosterone states (CHF, Cirrhosis)

 • Add ACETAZOLAMIDE to correct a contraction metabolic alkalosis & further augment diuresis.

 • ULTRAFILTRATION is indicated for removal of fluids in volume overloaded patients who are refractory to diuresis. - Timing is controversial. Early nephrologv consult may be associated with improved survival in AKI.



- Nick Mark MD @nickmmark



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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