Principles of management

1. Establish sources and degree of fluid and electrolyte losses.

2. Assess patient for signs of (i) intravascular fluid depletion — hypotension (e.g. following changes in posture, PEEP, vasodilating drugs) oliguria, increasing metabolic acidosis, thirst, (ii) total body NaCl and water overload — i.e. gravitational oedema.

3. Measure urea, creatinine, osmolality and electrolyte content of plasma and urine.

4. As appropriate, either replace estimated fluid and electrolyte deficit or increase excretion (with diuretics, haemofiltration). For rate of fluid and specific electrolyte replacement see individual sections.

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