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So this would mean a liter of sodium chloride. So it would cover her sodium and chloride requirements. Um We're topping this up with 60 million most of taxing for 24 hours. So she'll get what she needs um in terms of fluids, this is 1.5 letters and we're giving her a bit of dextrose as well. Um Just to maintain it again, this is just a very theoretical example of how you would prescribe fluids. In, in practice, I've not seen a patient been fasted for 24 hours. So they might just be taken to theater, you know, three hours after. And in that scenario, when they return, you can do a reassessment and if they're eating and drinking, then you can just stop the fluids. But if they're not maintaining their oral intake, then you can um continue with the fluids and just keep reassessing the patient's and other considerations as well as to calculate any existing um fluid electrolyte deficits or accesses and any ongoing ones. And then we would add or subtract these values from the standard fluid maintenance regimen. So nice has a chart here which just shows the electrolytes that are lost depending on the types of body fluids. So you have um electrolyte loss is from vomiting or diarrhea versus biliary drainage losses as well. So, we're going to go through another word. For example, this is a 70 kg man. Um with ongoing vomiting, we know that he's vomited 1.1 liters of the past four hours and this is now subsiding. We assessed him, he was unstable. So we needed to give him some fluids and he responded to one liters of Hartman's. We reassessing. He looks, he still looks volume depleted. He's not really able to eat or drink much and his bloods show a hyperkalemia of three. He's got no other fluid distribution issues because it's just gastroenteritis. So what, so we'll start with the routine maintenance requirements. How much fluids and electrolytes does this patient need for the next 24 hours? Would anyone like to type out the values? Yep. One millimeter per kilogram every 24 hours. That's for the electrolytes. So he'll need 70 million. Most of potassium, sodium and chloride. What about fluids? How much water does he need? Yeah. So around that value exactly in 5200 g of glucose per day. So if we multiply it by 25 to 30 mils, he'll knit this much um of routine maintenance fluids. So in this, in this case, the patient has an ongoing vomiting. We anticipate heat is not going to tolerate fluids as well in the next 24 hours. So the total requirements, aside from the routine maintenance, we need to factor in how much fluids he has already lost from the vomiting before he came in and how much he will continue to lose just because he's not eating or drinking very well. So this is these are his routine maintenance requirements and this is the chart which just shows the amount of electrolytes lost through vomiting. So we know that he's lost 1.1 literacy of fluids if we multiply it, if we multiply. So heart mints or saline is fine, either way for resuscitation, they can be used interchangeably. I just put Hartman's as an example, but we could, we could have used a normal Saline as well. Is that answer? Okay. So we know that this patient lost 1.1 liters of fluids. If we multiply it by sodium, he's lost 44. Um 1.1 multiplied by 100 and 40 we get 154 and he's lost 15 millimeters of potassium as well. But we have given him one liters of apartments. So that's mostly replaced the fluid loss that would have replaced the sodium and chloride deficits. And Hartmann's contains five million most potassium. So we still have a deficit of 10 million most of potassium. In this case, for estimating his ongoing losses. Again, there's no hard and fast rule. Um It's subsiding. So we can reasonably say he might lose one liters over the next 24 hours. Um So that would translate to 14 minimus of sodium, 14 millimeters potassium and 100 14 million most of fluoride as well. So, his total requirements, we've calculated his routine maintenance on the upper end. It's 2.1 liters of fluids and we estimate he's going to continue to lose one liter. So that's 3.1 liters. His glucose needs 5200 g per day and sodium wise, he needs 70 sodium and chloride. He needs 70 each for maintenance. We already know that that's been replaced. So he has no previous deficit, but he will still have an ongoing loss. So we at 40 and 100 and 42 17, we get 100 and 10, 210 and potassium as well. He still has a five, he still has a 10 million more deficit and he's got an ongoing loss of 14. So that translates to 94. Um I get, I appreciate this is quite technical, but it's just an example of how you work through the values. So we know that this is the amount that he needs over the next 24 hours factoring in any previous deficits and ongoing losses. So again, this is a possible regimen, we could give him a liter of sodium chloride that would cover his deficit and sodium um and we could supplement this with one liters of that screws as well. Just so he gets some glucose and we can add in potassium to these bags so that he gets around 100 millimoles of potassium. So this won't replace his electrolyte deficits. Exactly. But it's just a rough guide of how you would calculate it in practice. Um So I appreciate these were, this was quite a technical example in real life as an F Y one, it is highly unlikely you will have time to sit down and calculate all these individual values as thoroughly. Um They might ask you um to calculate values in exams, for example, the amount of electrolytes they need for the next 24 hours like in M C Q s and stuff. But in real life, prescribing fluids is sort of a signs as well as an art. So it's worth just knowing how to do a good fluid status assessment, knowing the basic principles of um fluid resuscitation and maintenance and just knowing the recommended values as well to help guide you to make good decisions for your patience. So in summary, we've just covered the different types of IV fluids. We've covered how to do a fluid status assessment, how to prescribe resuscitation and maintenance fluids as well. And these are my references. So the worked examples were taken from Kiki matics. It's quite, quite good resource there with all like the links to the nice guidelines and tables as well. Mind the Bleak has a very good um lecture on prescribing fluids and these are the nice guidelines as well for the algorithm? Okay. Are there any questions, did you all understand the second worked example? Like I appreciate it was quite technical but it's just an example of how you would calculate things really. But in real life it's more or less like an estimate and you always just reassess the patient to see how they're responding to what you've given them. Okay. No worries if there anymore. Yeah, I'll just hold on for about five more minutes if there any more questions or if you would like to see the worked examples again. Yeah. Um I think this is coordinated by the surgical society. So I will send the slides to them and they might send it up to you guys or upload it. I think part of hydra also, I think part of it was reported. Um but we'll send out the slides. Okay. Well, thank you for attending. So I think there might be a feedback link Cheryl. So she's the post. Um I'll just text her and see if there's a feedback link that we can send out. It's just helpful for me as well. Okay, sorry, I'll just, I'm just going to post the feedback link here if you guys can. So in that would be appreciated. Sorry, they just sent me the link. So. Oh, thank you.