1. determine when is the leaking/critical phase starts:
- symptoms: vomit diarrhea, epigastric pain.
- signs: pleural effusion
- lab: drop in alb (minus 6hr) raised hct
2. determine when is the expected completed 48 hr
3. then we know when is the resorption phase should start
4. calculate how much fluid has been given: net cumulative positive divide with weight
expected total leak
5. type of fluid to be given:
- maintainance drip: 2ml/kg/hr or 1ml/kg/hr +orally
- leak: first 24hr: 1-2 ml/kg/hr, next 24hr: 0.5ml/kg/hr
- deficit
- insensible loss: febrile: 500ml/day
- on going loss: volume to volume repolacement --> diarrhea, vomiting, pv/pr bleed
then u get total fluid to be given perhr
6. check whether patient has other complications: sepsis, hepatitis, carditis, AKI
7. monitor
- abg 2hrly --lactate, hco3, hct
- fbc 4hrly -- hct
- coag, lft, ck, rp --may be bd
8. approaching expected reabsorption phase: REDUCE DRIP REDUCE DRIP watch out features of overload, kiv frusemide, may need intubation
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