Sometimes it is challenging to decide whether to administer fluid or not. Following case shows one of these difficult situations:
A 70-year-old patient underwent laparotomy for intestinal ischemia. Approximately 15 cm of ileum had to be resected for necrosis and perforation of Meckel´s diverticulum. Embolectomy from the peripheral part of the superior mesenteric artery was also performed. A resection with the establishment of end-to-end anastomosis was performed. Empiric antibiotic therapy was started due to local peritonitis. Patient´s history had encompassed tricuspid regurgitation, permanent atrial fibrillation and chronic renal insufficiency so far.
Patient´s condition still required administration of noradrenaline (0.5 mg/h). Oliguria was also still persisting (0.25 ml/h). Perfusion of peripheral parts and level of lactate were both physiological.
Did noradrenalin compensate the potential volume depletion (if present)? Was it necessary to administer fluid to increase perfusion of kidneys?