Rx Note

Introduction Ascites is a pathologic accumulation of fluid in the peritoneal cavity most often caused by cirrhosis , but other causes include malignancy, nephrotic syndrome , heart failure , malnutrition and infections such as peritoneal tuberculosis. It can lead to the development of spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). The serum-ascites albumin gradient correlates directly with portal pressures. A SAAG gradient ≥ 1.1 g/dL suggests portal hypertension, most likely due to cirrhosis. Other causes include venous congestion such as from right sided heart failure. A SAAG gradient < 1.1 g/dL suggests other causes of ascites such as peritoneal carcinomatosis, chronic peritoneal infection, nephrotic syndrome, pancreatic ascites, and protein-losing enteropathy. NOTE: Treat ascites with a SAAG gradient of <1.1 g/dL by addressing the underlying aetiology as diuretics are often ineffective and may lead to volume depletion. Management There are many treatm...

Introduction Fluid balance is Estimating the input and output of fluid in the body. Accounting for redistribution of fluid and electrolytes outside the plasma volume. In principle, all fluid into and out of the body should be measured and recorded on a fluid balance chart. In actual clinical practice, it is more common to express an opinion about fluid status. Assessment of fluid status Signs of pulmonary or peripheral oedema Dry mucosa, sunken eye appearance or patient feeling thirsty Poor urine output (<0.5 ml/kg/hour) Slow capillary refill (more/less than 2 seconds) Blood pressure - central venous or jugular or postural hypotension Pulse and heart rate Altered conscious state Loss of weight over days (not weeks) Concentration of biochemistry May also consider fluid challenge by passive leg raise or fluid bolus protocol. Intravenous Fluids Intravenous fluids are used to replace fluid losses and treat various conditions . They are categorized as crystalloids or colloids. Crystalloi...