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Management - further

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

If the fluid challenges have been given, and there has been no response to the frusemide, the next stage is to site a central venous line to get a clear idea of what is actually going on - ie has the patient been adequately rehydrated, are they in heart failure, etc. The column of fluid is lined up with the sternal notch or mid axillary point; the normal value is anywhere from 0 to 6cm. The physician is looking for some sort of response to a fluid challenge, interpreted as follows:-

  • full - pressure up and stays up for at least an hour
  • not full - pressure rises but falls within 15 minutes

The patient should be resuscitated accordingly.

The next step from here is a renal dose of dopamine - 2 to 5 micrograms per kg per minute; at this dose it is a specific renal vasodilator.

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