IV fluid for a PT on a Fluid restriction? ! ? !

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Specializes in Cardiology, Oncology, Medsurge.

Can anyone tell me why a renal doctor would order 60ml of NS/hour for a patient on a fluid restriction. Now he did order a UA, random urine creatinine, random urine sodium. Was it to increase her urge to micturate??? She did not have a foley. I think her fluid restriction was 1500 q day.

Ps. this patient had ETOH related liver disease with anasarca +3 edema, ascites,Thoracentesis ordered for the morning, wheezes and crackles, jaundiced and in terrible pain and you know the sad tale of woe with a ETOH 48yr old on her way out....sad sad sad too sad!

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Specializes in LTC,Hospice/palliative care,acute care.
Can anyone tell me why a renal doctor would order 60ml of NS/hour for a patient on a fluid restriction. Now he did order a UA, random urine creatinine, random urine sodium. Was it to increase her urge to micturate??? She did not have a foley. I think her fluid restriction was 1500 q day.

Ps. this patient had ETOH related liver disease with anasarca +3 edema, ascites, wheezes and crackles, jaundiced and in terrible pain and you know the sad tale of woe with a ETOH 48yr old on her way out....sad sad sad too sad!

it is too sad-especially when you consider she is commiting suicide slowly...

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Specializes in Cardiology, Oncology, Medsurge.
it is too sad-especially when you consider she is commiting suicide slowly...

Sad thing is she has no way to get out of the sand trap she's in. Damage has been done, only a downward trend awaits her ;-(

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the pt isn't exceeding the 1500mls/day, w/the iv tx.

is she on diuretics?

is she receiving iv albumin?

there are different considerations on why she'd be receiving iv.

even with ascites and edema, she can still be dehydrated.

hopefully they're keeping her comfortable.

wishing her peace.

leslie

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A gentle re-hydration? Patients with liver disease will third-space because of low albumin/protein levels, etc., but can still be intravascularly volume-depleted.

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Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

Without knowing her cardiac history.....

I would wonder if she might also have some heart issues....and if a person is too volume depleted, sometimes it will cause the heart to fail worse, because eventhough it is weak, it still needs something to pump around...

just because a patient is 3rd spaced, anasarca, et al....doesn't mean she is adequately hydrated in the right places....she can be volume depleted in her vascular space...which is further damaging to her kidneys and liver.....sometimes renal docs will do a gentle hydration with a gentle diuresis....just a thought....

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Specializes in Cardiology, Oncology, Medsurge.

The renal doc stopped the diuretic Lasix and she has not received albumen recently...but good knowledgable answers.

I like the cardiac reasoning, volume depletion reasoning...ie the fluid in the circulation needing added volume. Come to think of it her BP was in the 90s. Next time I see the renal Doc I will ask him. Thanks to all!!!

You all have me eager to get back to work and look at her labs...especially looking at possibly a high BUN, high osmolality...dehydration might be the key!

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I have seen this before with other diseases. Another one that can confuse is a patient with hyponatremia that remains on a no salt diet. Eating salt does not bring up the na level as needed.

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The renal doc stopped the diuretic Lasix and she has not received albumen recently...but good knowledgable answers.

I like the cardiac reasoning, volume depletion reasoning...ie the fluid in the circulation needing added volume. Come to think of it her BP was in the 90s. Next time I see the renal Doc I will ask him. Thanks to all!!!

You all have me eager to get back to work and look at her labs...especially looking at possibly a high BUN, high osmolality...dehydration might be the key!

it sounds like a case of hepatorenal syndrome.

http://www.en.wikipedia.org/wiki/Hepatorenal_syndrome

often in these cases, vasculature is near collapse.

very sad.

i vote comfort measures.

leslie

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Specializes in Cardiology.

Acute renal failure? Sounds like the lasix may have been taxing her kidneys. Hydration can and often does improve kidney function.

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Specializes in MICU/SICU.

Make sure you update us tomorrow!! We need to know the lytes and urine Na/osmo. If she is hyponatremic, he would restrict fluids (free water) and give NSS.

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it sounds like a case of hepatorenal syndrome.

http://www.en.wikipedia.org/wiki/Hepatorenal_syndrome

often in these cases, vasculature is near collapse.

very sad.

i vote comfort measures.

leslie

I agree totally.

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