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What is a fluid challenge?

Updated: 10/10/2023
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13y ago

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A "fluid challenge" means to administer IV crystaloid fluids (e.g. Normal Saline) to a patient requiring volume replacement for (possible) hypovolemia. There is no defined drip rate for fluid challenge. Rather, the goal is to infuse a given volume, usually between 150-250 cc's as rapidly as is reasonable. The drip is run "full out" in a near constant stream of drips using a wide bore (e.g. 18 or 16 gauge) catheter and a macro drip set.

Be careful to monitor the patient's response carefully and check blood pressure, heart rate, and lung sounds frequently, so as not to overload the patient, especially those who show signs of pulmonary edema due to cardiogenic shock as fluid overload may cause respiratory failure (flashover -- you DO NOT want to have to start suctioning frothy pink sputum from your PT's mouth and throat).

The goal is to see an increase in BP over a few minutes.

You can continue to infuse liquids as long as the patient's BP remains low and their lungs are clear. If you find you are infusing a large volume without a corresponding increase in BP, consider rechecking your patient for uncontrolled bleeding since the fluid has to be going somewhere. Don't forget to monitor the abdomen and pelvis for possible internal bleeding: look for Cullen and Grey-Turner signs (both relatively late signs of internal bleeding) as well as abdominal swelling, increased percussion, muffled bowel sounds, and rigidity which can indicate blood voiding into the abdomen (hemo-peritoneum).

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13y ago
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10y ago

a test for diff between acute renal failure and acut tubular necrosis by giving the pt 1 ml saline and lasix and monitoring central venous pressure .

in acute renal failure >>>there is urine output

in acute tubula necrosis >>no urine out put

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When urine output is less than 30 ml's intervention of a fluid challenge or diuretics is indicated?

In anuria or oliguria, a fluid challenge is indicated plus a rechecking of a catheter for blockage/loss of patency if one is sited. Diuretics e.g. lasix are NOT prescribed.


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