Fluid Overload questions

[zacarias]

hey all,

have a couple questions regarding fluid overload. i had a patient a few weeks ago who had pancreatitis and earlier she satting 98 and feeling fine with 250cc/hr saline going. this was before my shift. when i assessed her, she had quite a few crackles and she was satting about 92. i wanted to turn down her fluids but the doc wanted to put her on o2. i did the latter and later her sats were 98 again and her crackles were gone.

my question is, she was young 35 with no cardiac hx. was i silly in worrying about fluid overload? it possibly just could have been atelectasic crackles from her being in bed so long. also, does supplemental 02 create enough pressure to push fluid back into the pulmonary vasculature should there be little fluid?

from my other experiences, it seems that crackles will be heard sometimes long before sats actually start dropping in cases of fluid overload. your thoughts? thanks again. :)

[amethyst221]

Was this patient in an ICU? How severe was the pancreatitis? The physician should have a very good idea of what the patient's fluid status is so you were right to call. Severe pancreatitis can cause systemic inflamatory response syndrome which can cause third spacing. You would not want to slow down the fluids on a patient with that condition. They can go into hypovolemic shock and brady down to cardiac arrest. There is a condition known as noncardiogenic pulmonary edema and that is a hallmark of ARDS (Adult Respiratory Distress Syndrome) which is treated with higher concentrations of oxygen.