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Important in case anyone wants to contact you to ask about the changes made

• REMEMBER: a drug chart is a legal document, all actions must be traceable with appropriate ownership of changes to medications
• Patient has low BP and spironolactone is a BP lowering drug

• Anti-emetic medication is best prescribed as PRN
• All medications have side effects therefore patients should normally receive it when they need it
• Except if it is prescribed as anticipatory medication in which case it can be prescribed as regular prescription

• Ondansetron, prochlorperazine are two other commonly used anti-emetic medications
• These could also be used with the appropriate dosing as this patient has no contraindications

• The patient has been vomiting
• IV prescription is preferred over oral in case of nausea and vomiting

• As required medications (PRN) must NOT exceed there guided limit
• Be careful not to assume that it can be given at any frequency

Normal saline is most commonly used for resuscitation fluids

• This patient has heart failure, advised resuscitation fluid is 250ml for these patients
• This scenario is challenging as the patient could easily be fluid overloaded but they are also dehydrated
• Close monitoring after every intervention is necessary to make sure interventions are appropriately balanced

• It is appropriate to prescribe either NaCl/Hartmann's
• NaCl is more appropriate as Hartmann's is more of a physiological fluid so it contains potassium which is already raised in this patient

• Maintenance fluid is calculated by working out the patient's weight (kg) multiplied by 25-30ml
• In this case, the patient is 62kg and will require between 1.5-1.8L of saline over 24 hours
• As she has heart failure you might want to be more conservative and opt for 1.5L
• You can prescribe 1L over 12 hours and then another 500ml over 12 hours

• Average fluid requirement of an adult is 2-2.5L/day or 25-30ml/kg/day
• This should be as equally spaced out throughout one day as possible

• Where possible oral fluids should be encouraged
• Considering the patient is nauseous she may not tolerate high volumes
• Best practice dictates IV fluids until oral fluids can be tolerated

Patient is dehydrated secondary to vomiting - pre-renal cause of AKI