adultdehydrationguidelinejuly2015(1)
TRANSCRIPT
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7/26/2019 AdultDehydrationGuidelineJuly2015(1)
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POAC CLINICAL GUIDELINE
Acute Adult Dehydration
POACClinicalGuideline:AcuteAdultDehydration
July2015
PersistentVomitingand/orDiarrhoea
Hyperemesisintractablevomitingin
pregnancy10%)Significantthirst
Tachycardia
Lowpulsevolume
Coolextremities
Reducedskinturgor
Markedhypotension
Confusion
TrialofOralFluids
+/ antiemetic
34litresfluidover24Hrs
Observationnotrequiredin
clinic.
POACFUNDINGDOESNOT
APPLY
TrialofOralFluids+antiemetic
Observeinclinicforupto60minutes
underPOAC
Aim34litresoralfluidover24hours
INVESTIGATIONS
Consider:
Glucose
MSU
Weight
Electrolytes
FaecalSpecimen
Admission
Recommended
Ketones+++
Ketones0+
Ifinsufficient
response
to
oral
intake:
IntravenousFluidsANDAntiemetic
NormalSaline
1000mlstat(1820gangiocath)
Reviewhydrationstatus
LIMIT=2000mlperconsultation
WATCHFOR
Signsoffluidoverload
Inadequateresponse
Persistingfluidlosses
Ketosis
Deteriorationof
symptoms
Signsofevolving
illness
MigraineGiveIVstemetil12.5mg
IVfluidsnotindicated
unlesspatientis
dehydratedandisnot
abletotakeoralfluids
Reviewdailyandrepeatcycleprn
Iffluidsrequired>2LIVperday/cycleAdmit
Monitorintake/losses
Encourageoralfluids
Providepatientwithcontact/emergencynumbersand
instructions
AIMS
Improvementinclinicalsigns
Achieveadequateurineoutput
(Recordfluidbalance)
Reductionin
fluid
losses
Abletomanageoralrehydrationsolutionsafelyathome
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7/26/2019 AdultDehydrationGuidelineJuly2015(1)
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POAC CLINICAL GUIDELINE
Acute Adult Dehydration
POACClinicalGuideline:AcuteAdultDehydration
July2015
Aim
Toenablethepatienttocontinuetomanageadequateoralfluidrehydrationsafelyathome.
Dehydration
Thisguidelineisspecifictobodyfluidlossessecondarytohyperemesis,vomitingand/ordiarrhoea. Itaimsto
serve as a general guideline and support aid in the assessment and management of mild to moderate
dehydration.Severedehydration istheresultof largefluid lossesandmaybecomplicatedbyelectrolyteand
acidbasedisturbanceswhichrequiretreatmentandobservationoveraprolongedperiod.Severedehydration
isnotsuitableforcareunderPrimaryOptionsandadmissiontohospitalisrecommended.
Exclusions
Vomitingand/or
diarrhoea
are
symptoms
which
may
result
from
awide
range
of
diagnoses.
A
working
diagnosis is important in the management of subsequent dehydration. Patients with the following are
excludedandadmissionshouldbeconsidered:
Children
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7/26/2019 AdultDehydrationGuidelineJuly2015(1)
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POAC CLINICAL GUIDELINE
Acute Adult Dehydration
POACClinicalGuideline:AcuteAdultDehydration
July2015
Investigations
Investigationsmay
not
be
necessary.
Clinical
judgement
is
recommended
following
the
assessment
of
each
case.
Ifrequired,simpletestswhichareeasytoperforminclude;
FaecalCulture
MSUinfection/ketones
Glucosefingerprick
Electrolytes Electrolytedisturbancesand renal impairmentmay result fromexcessive fluid losses
andmaybeespeciallyimportantinolderpatients.
Pregnancytest
Fluid replacement
Forbothmildandmoderatedehydrationconsideratrialoforalrehydrationcombinedwithan antiemetic.
(Metoclopramide inpregnancy, andmetoclopramideorprochlorperazineorondansetron inNonpregnant
cases) Specific oral fluid solution is at the Physicians discretion.Normal saline is the intravenous fluid of
choice,howeverPlasmalyteisanacceptablealternative.
It isrecommendedthatthe intravenousresuscitation fluidvolume isrestrictedtoanupper limitof2000ml
per consultation. Fluid volumes beyond this level are likely to require more investigation and clinical
monitoring.Shouldtheclinicianfeelfurtherfluidvolumesbeyondthislevelareneededthendiscussionwith
theappropriatespecialistorhospitaladmissionisrecommended.
Inall
cases
of
intravenous
fluid
replacement,
details
of
fluid
balance
should
be
recorded.
Observation
and
reassessmentofhydrationstatusatregular intervalswillallowcalculationoffluidvolumerequirementsand
reducerisksoffluidoverload.
DISCLAIMER:
Thismanagement guideline has been prepared to provide general guidancewith respect to a specific clinical
condition. Itshouldbeusedonlyasanaidforclinicaldecisionmakingandinconjunctionwithotherinformation
available. Thematerialhasbeenassembledbyagroupofprimarycarepractitionersandspecialists inthe field.
Whereevidencebasedinformationisavailable,ithasbeenutilisedbythegroup. Intheabsenceofevidencebased
information,theguidelineconsistsofaconsensusviewofcurrent,generallyacceptedclinicalpractice.
Thisguidelineshouldnotreplaceprofessionalclinicaljudgmentinmanagingeachindividualpatient.
ENDORSEMENT:
ThisguidelinehasbeenendorsedbythePOACClinicalReferenceGroup,July2015