Fluid Therapy and Nutrition

Abstract

When healthy, we enjoy the eating and drinking essential to maintain a state of metabolic balance. Drinks other than water contain electrolyte, energy and protein; conventional food contains water and electrolyte. Consequently, in health our fluid therapy and nutrition are inseparable. The same may be true for the intensive care patient but in other cases, or at some stage of an illness, the fluid therapy and nutrition require separate plans. It is important to remember that fluid therapy can readily be given without giving nutrition, but nutrition always includes fluid therapy. The newcomer to intensive care should appreciate that the treatment of each patient admitted to a general ICU has to be arranged in a priority list which includes fluid therapy and nutrition, but these are often third or fourth on the list. Since nutrition tends to be forgotten, we have made a rule that all patients requiring intensive care for more than 48 h must be given appropriate nutrition. The requirements for fluid therapy and nutrition must depend on the disturbances caused by the disease and these were described in Chapter 5. Nevertheless the requirements of most ICU patients can be predicted from published observations. This means that standardized schemes can be drawn up; such policies form one of the essentials of intensive care as was described in Chapter 1. The efficacy of such schemes for the nutrition of the intensive care patient was established in 1964 (Peaston, 1967). To practice fluid therapy and nutrition, the trainee requires knowledge of the disturbances of balance described in Chapter 5. In addition, the nurse or doctor requires an elementary knowledge of the science of nutrition. Aseptic methods and the techniques of tube feeding and central venous cannulation are skills that are readily acquired. The appropriate attitudes were described in Chapter 1. Fluid therapy and nutrition in renal failure are left until later chapters.

There must be an orderly process in treatment … they should be nudged, not kicked, in the right direction. Francis Moore, 1959