Week 14: Fluids and nutrition

Things to consider

• Why do we give fluids?

• Which fluid should we give?

• Electrolyte replacement - When to treat? How?

• Hyper and hyponatraemia

• Hyperchloraemic metabolic acidosis - is it a thing? Should you care?

• What's the evidence base for nutrition on critical care?

Resources

• Fluids

  • Fluids: Turing the Tide (ICS Education)

  • Fluid selection and subsequent deresuscitation (IBCC)

  • Choice of fluid type (BJAEd)

  • Fluid bolus therapy (LITFL)

• Electrolytes:

  • Sodium, potassium, and the anaesthetist (AnaesthesiaUK)

  • Cations (BJAEd)

  • IBCC guides: HyperNa/hypoNa, hyperK/hypoK, hyperCa/hypoCa, hyperMg/hypoMg, hyperPO4/hypoPO4

  • Normal saline intoxication (Deranged Physiology)

• Nutrition

  • Nutrition in critical care (BJAEd)

  • Nutrition for the intubated patient (IBCC)

  • Review of the ASPEN guidelines (PulmCrit)

  • LITFL: Nutrition literature summary and glucose control in the critically ill

Key trials and guidelines

• Fluids

  • NICE CG174 - IV fluids

  • Colloids vs crystalloids Cochrane

  • Use balance crystalloids: SALT, SALT-ED, SPLIT

  • Don't use starch: 6S, CHEST

  • Don't use albumin: ALBIOS, SAFE

  • How much: CLASSIC, RELIEF, OPTIMISE

• Nutrition

  • British Association of Dieticians, ESPEN, and ASPEN critical care nutrition guidelines

  • Early goal-directed nutrition

  • Energy density: TARGET, permissive underfeeding,

  • Glucose control: NICE-SUGAR, Intensive Insulin Therapy

  • Parenteral nutrition: Timing, vs enteral,

Have we missed something?

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