Improving fluid balance

• Fluid balance is also known as fluid homeostasis, describeds the balancing of the bodys fluid input and output levels to prevent the fluid concentration from changing.
• In order to maintain the necessary balance of nutrients, oxygen and water the adult body generally requires an intake of 2 to 3 liters per day, with approximately the same output.

• A fluid balance chart is used to document a patients fluid input and output within a 24 hour period.
• This information is used to inform clinical decisions (such as medication and surgical interventions) from medical staff, nurses and dieticians who all expect accurate figures in exact measurements.
• When completing a fluid balance chart, you could record any fluid intake by the patients in exact quantities, as well as the type of fluid.
• For example, if you give the patients a 200ml glass of water, you will record that information. You should also keep a running total.
• Output (urine, loose stools, vomit etc) should also be measured in exact quantities.

Positive fluid balance (hypervolemia)

A positive fluid balance indicates that the patients fluid input is higher than their output. The condition describing excess fluid is known as hypervolaemia of fluid overload.

• Excessive fluid administered
• Congestive cardiac failure (condition in which the heart 's function as a pump is inadequate to meet the body's needs)
• Fluid resuscitation (replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes)
• Kidney injury 

• Pulmonary oedema
• Oedema
• Rapid weight gain
• High blood pressure
• Heart problems (including congestive cardiac failure)

• Offload the excess fluid- consider diuretics
• Consider dialysis in the case of kidney failure
• Monitor the patients heart rate- Observe electrolyte imbalance and obtain blood tests
• Support any breathing complications
• Apply continuous haemodynamic monitoring (determining the functional status of the cardiovascular system)
• Perform an ECG (Electrocardiogram- check your heart's rhythm and electrical activity)

Negative fluid balance (Hypovolemia)

• A negative fluid balance indicates that the patients fluid output is higher then their input. The condition describing inadequate fluid is known as hypovolaemia.
• Hypovolaemia is caused by significant fluid loss (hypovolaemic shock is defines as a loss of more than 20%). preventing the heart from circulating enough blood around the body. This can result in organ failure.
• Hypovolaemic shock is life threatening.

• Significant and sudden blood loss (e.g. from wounds, accidents, endometriosis)
• Exessive diarrhoea
• Excessive vomiting
• Excessive sweating
• Surgery
• Severe burns
• Asministration of diuretics

• Hypotension (low blood pressure)
• Tachycardia/arrhythmias (Raised heart rate/ irregular or abnormal heart rhythms)
• Decreased urine output
• Altered mental state
• Fluid and electrolyte imbalance
• Deranged clotting factors
• Signs of dehydration
• Cold and clammy skin
• Weak or absent pedal (foot) pulse (caused by blood being redirected to vital organs as there is not enough fluid in the circulatory system)

• Administer intravenous fluid replacement therapy
• Administer intravenous blood products if required
• Replace electrolyte imbalance
• Support any breathing complications 
• Apply continuous haemodynamic monitoring
• Perform a ECG

• Record correctly and accurately your patients fluid input and output
• Early detection of an imbalance will allow appropriate reversal and will reduce the risk of patients being admitted into critical care.
• In order for the task to be performed adequately, it is essential that staff are educated about the importance of fluid balance, and that any necessary interventions are made to ensure that the process is completed properly