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Fluid Intake and Output Record

Fluid Balance Chart Name: Carol


Registration No.
INTAKE: OUTPUT
Date/Time Type of IV Fluid and Oral NGT- Vomit Urine Drains From Remarks and
Amount Feed Output NGT Observation
8:00 Am IVF - 750cc 350cc
10:00 Am IVF - 690cc 245cc
12:00 Nn IVF - 630cc ---
2:00 Pm IVF - 580cc 650cc
8:00 Am Water
250ml
10:00 Am Water
50ml
12:00 Nn Water
140ml
2:00 Pm Water
210ml
8:00 Am ---
10:00 Am ---
12:00 Nn ---
2:00 Pm 300ml

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