Fluids in special groups

Fluids in the elderly - Marcia Mac Dougall


We are very poor at managing fluid balance in the elderly - why?


  • Comorbidities
  • Less reserve
  • Easily overloaded
  • Easily dehydrated
  • Polypharmacy
  • Major surgery


Progressive loss of renal function from the age of 40

Dehydration a big problem - difficulty to diagnose and often don't complain of thirst

Important to do the simple things well - but especially in the elderly

Ended with the IFAD mantra:


“The right amount of fluid, to the right patient, at the right time”


Fluids in right heart failure - Paul Elbers


All intensivists should be aware about the right heart failure

RAP cannot predict volume responsiveness

Increase following fluid administration may imply impending right heart failure

From a Guytonian perspective: septic RV dysfunction should make you very cautiously consider giving fluids



Guess what - not too much, not too little, just the right amount

Always try and apply fluid strategy with the right heart in mind and physiology driven

Multimodal monitoring is your friend

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