You are on page 1of 2

Wd/Ed>>

Wd/Ed>>
PATIENT LABEL FLUID BALANCE CHART Mid Cheshire
d Hospitals NHS
NHS Foundation Trust
Ύdd/E'hd</Ez/E:hZz;</ͿΎ
*ASSESSING 
FOR ACUTE KIDNEY INJURY(AKI)*
DATE
WZ^/^dEdhZ/EKhdWhdфϬ͘ϱŵůͬŬŐͬŚŽƵƌDz/E/d</͘ t/',d
PERSISTENT URINE OUTPUT < 0.5ml/kg/hour MAY INDICATE AKI.

&K>>KtK>/'hZ/ͬ<//E&KZDd/KEKsZ>&
FOLLOW OLIGURIA / AKI INFORMATION OVERLEAF
&K>>KtK>/'hZ/ͬ<//E&KZDd/KEKsZ>& WEIGHT

d/D KZ> /s /s EdZ> ,KhZ>z ZhEE/E' hZ/E E^KͲ ^dKD Z/E Kd,Z ,KhZ>z ZhEE/E'
&>h/^ D/d/KE & dKd> dKd>/E '^dZ/ dKd> dKd>
 /E dh Khd Khd
Ϭϭ͗ϬϬ             
ϬϮ͗ϬϬ           
Ϭϯ͗ϬϬ           
Ϭϰ͗ϬϬ             
Ϭϱ͗ϬϬ             
Ϭϲ͗ϬϬ           
Ϭϳ͗ϬϬ           
Ϭϴ͗ϬϬ             
Ϭϵ͗ϬϬ             
ϭϬ͗ϬϬ           
ϭϭ͗ϬϬ           
ϭϮ͗ϬϬ             
ϭϯ͗ϬϬ             
ϭϰ͗ϬϬ           
ϭϱ͗ϬϬ           
ϭϲ͗ϬϬ             
ϭϳ͗ϬϬ             
ϭϴ͗ϬϬ           
ϭϵ͗ϬϬ           
ϮϬ͗ϬϬ             
Ϯϭ͗ϬϬ             
ϮϮ͗ϬϬ           
Ϯϯ͗ϬϬ           
Ϯϰ͗ϬϬ             
dŽƚĂůƐ             
E͗ůƵĞƐŚĂĚĞĚƌŽǁƐʹŵĂŶĚĂƚŽƌLJZƵŶŶŝŶŐdŽƚĂůƐƚŽďĞĚŽĐƵŵĞŶƚĞĚ͘Ϯϰ,KhZ&>h/>Eс
Fluid Balance Chart V3 2013

  Mid Cheshire Hospitals NHS
NHS Foundation Trust

"&/1236!4*)4 %0&%"8&0 "  ,0   9
/#! 12342 , 23454  
 #  
 
    --   -%  --   --
, -
-
, -, / , /

'34 '1-2 , '1-2 ,
"&/1236!4*)4 :%0&%"8&0 (34 (1-2 , 1-2 ,
)34 )1-2 , '1- ,
" 6#%%&%*;&
  <  6% =$*">! *34 *1-2 , &1-2 ,
+34 +1-2 , &'1-2 ,
34 1-2 , '1-2 ,
34 1-2 , (1-2 ,
 "$!+0"0
$*"% "6&#" $+ & !!7")
 9 
"0&"0&6%&$""& :ȝmol/l6&7""?0
   
32@"0&"0&6%&$""&8&A#$+0 
/  
 "&/1236!04*)4 :%0&%"8&0
*  
 )  
$*"6$$)&6&
 !  
"#&" +;&$&%$0&  0/&%"$!"0& &$!0
  

x  
 9  4 9 C 

4 x 
/ 
< 

 <
  
9 $*"4 9 C49  
 
x C 

    
 <<  
x C4  9  D  x   <  < <99  
 !"#$!$%&%$=60#B0>
!"#$!$%&%$=60#B0>
x #95 <  
 9  
   
x  
"
5
x %   
    5 x 

4% 
%
< 
 x  
"
5
x  
 9
 %*
  
   9
 E   x  
 9
x      
   

x      
   

x      


   x       


Fluid Balance Chart V3 2013

     

You might also like