CASE 4

5 days after a liver transplant, a 48 year old man has a pyrexia of 40.8 degrees C. His charts for the last 24 hours reveal:

urine output: drain output: nasogastric output: blood transfusion: IV crystalloid: oral fluids:

2.7 litres 525 ml 1.475 litres 2 units (350 ml each) 2.5 litres 500 ml

On examination he has a tachycardia. His supine BP is OK, but you can’t sit him up to check his erect BP. His serum [ Na+ ] is 140 mmol/l. Questions:

1. How much IV fluid is he likely to need over the next 24h, assuming these outputs remain the same? (it is of course unlikely that they will be quite the same)

2. What fluids would you use?

HINTS: You can get a hint by clicking below.

1. How to approach the first part of the question

2. How to approach the second part of the question

ANSWER: Only click here when you've written down answers to 1 and 2!

Show the answer. Indicative marks are also shown, as if this case was being used in an OSCE. (This would be a tough Q for an undergraduate exam).