Fluid and Electrolyte Management

TLDR

Fluid and electrolyte management is challenging because electrolytes shift across diverse settings and disease states, and existing equations fail to account for the wide clinical variability. The study aims to develop a fluid and electrolyte management plan that begins by correcting the underlying condition. The authors assess fluid balance to achieve euvolemia, then simplify electrolyte imbalances, design a supplementation plan that accounts for renal and gastrointestinal function, and emphasize frequent monitoring to restore homeostasis. A multidisciplinary team–developed plan improves continuity of care and ensures safe outcomes.

Abstract

Fluid and electrolyte management is challenging for clinicians, as electrolytes shift in a variety of settings and disease states and are dependent on osmotic changes and fluid balance. The development of a plan for managing fluid and electrolyte abnormalities should start with correcting the underlying condition. In most cases, this is followed by an assessment of fluid balance with the goal of achieving euvolemia. After fluid status is understood and/or corrected, electrolyte imbalances are simplified. Many equations are available to aid clinicians in providing safe recommendations or at least to give a starting point for correcting the abnormalities. However, these equations do not take into consideration the vast differences between clinical scenarios, thus making electrolyte management more challenging. The supplementation plan, whether delivered intravenously or orally, must include an assessment of renal and gastrointestinal function, as most guidelines are established under the assumption of normal digestion, absorption and excretion. After the plan is developed, frequent monitoring is vital to regain homeostasis. A fluid and electrolyte management plan developed by a multidisciplinary team is advantageous in promoting continuity of care and producing safe outcomes.