How can I effectively monitor and manage fluid status in a patient with acute heart failure?

Effective monitoring and management of fluid status in a patient with acute heart failure involves:

• Regular clinical assessment of fluid status by checking for signs such as changes in body weight, peripheral oedema (including abdomen, sacrum, genitalia, and ankles), raised jugular venous pressure, fine lung crepitations, and hepatomegaly.
• Monitoring vital signs including pulse rate and rhythm, blood pressure, respiratory rate, and oxygen saturation to detect fluid overload or hypovolaemia.
• Using intravenous diuretic therapy promptly to relieve symptoms of fluid overload, starting with either bolus or infusion, and considering higher doses if the patient was already on diuretics prior to admission.
• Closely monitoring renal function, weight, and urine output during diuretic therapy to assess response and avoid complications.
• Advising the patient on coping strategies for increased urine output and educating about symptoms of worsening heart failure such as rapid weight gain, increasing breathlessness, and swelling.
• Considering fluid restriction (e.g., 1.5–2 L/day) only in cases of severe symptomatic heart failure with signs of fluid overload or dilutional hyponatraemia, while generally not restricting fluids routinely.
• Using fluid balance charts and regular weight measurements (at least twice weekly) to track fluid status changes.
• Reassessing the patient frequently, especially if intravenous fluids are administered, using clinical examination and laboratory tests including serum urea, creatinine, and electrolytes.
• In cases of diuretic resistance, considering specialist referral for possible ultrafiltration.

These steps should be integrated into a multidisciplinary approach with regular follow-up and individualized care based on the severity and stability of the patient’s condition.

References: ¹,²,⁴,⁵