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Abstract Hydration is the missing part in nutritional care of the critically ill patients which have negative outcomes. Fluids imbalances can be classified Fluid volume deficit is the umbrella to define dehydration (water loss only), volume depletion and hypovolaemic shock. Fluid volume excess can be classified into over hydration (water gain only) and hypervolemia. Factors associated with altered hydration status can be classified into factors associated with fluid volume excess or deficit; and factors associated with fluid volume excess that include pathological causes such as renal, liver, and cardiac insufficiency; or therapeutic causes related to some medications such as corticosteroids or mechanically ventilation. On the other hand, other factor associated with fluid volume deficit that include increase insensible fluid loss (fever, infection) or sensible fluid loss (OTT loss, diarrhea) and decrease fluid intake (fluids restriction, impaired of swallowing). |