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Biochemical effects of a major fluid improvement programme – Marcia McDougall
2:00 PM - 2:15 PM
Fri Nov 23, 2018
Grote Zaal

Description

 Learning objectives

  1. Understand the impact of a hypotonic maintenance strategy on electrolyte the occurrence of hyponatraemia and hypernatraemia
  2. Understand the impact of a hypotonic maintenance strategy on electrolyte the occurrence of hyperchloremia
  3. Learn why this is important on a clinical level

Learning objectives:
1. To learn about the NICE intravenous fluid guidelines and their application
2. To understand how pharmacy and electrolyte data may be used to track a major change in practice
3. To appreciate that in any observational study it is important to be aware of other changes occurring in the hospital environment.
 
 
Take home messages:
1. Fluid guidelines can be introduced across a whole hospital and nation but it takes time and effort
2. Along with improving fluid prescription it is necessary to improve fluid balance charting and attention to hydration.
3. Reducing saline use reduces acidosis; using low sodium maintenance fluids does not adversely affect electrolyte balance.
 
Unfortunately I haven't published anything on this yet!  Getting there.
 
Refs: 
  1. NICE Guideline: Intravenous Fluid Therapy in Adults in Hospital: Clinical Guideline CG 174 Dec 2103
  2. Shaw AD et al.  Major complications, mortality and resource utilization after open abdominal surgery: 0.9% saline compared to Plasmalyte.  Annals of Surgery. 2012; 255 (5): 821-829
  3. Semler MW et al. Balanced Crystalloid versus Saline in Critically Ill patients.  N Engl J Med 2018; 378:829-839

  4. Lobo DN et al.  Problems with solutions: drowning in the brine of an inadequate knowledge base.  Clinical Nutrition (2001) 20 (2): 125-130

  5. Care of Older People (Health Improvement Scotland) reports: http://www.healthcareimprovementscotland.org/our_work/inspecting_and_regulating_care/nhs_hospitals_and_services/care_of_older_people/care_of_older_people_reports.aspx

Speaker
 
Marcia McDougall
Consultant in Anaesthetics and Clinical Lead for Intensive Care, Victoria Hospital, Kirkcaldy (Fife, Scotland)

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