Siruhanong Bisaya

11/04/2025

Closure of Ileostomy

Ileostomy Reversal SurgeryIf you had undergone surgery for colorectal cancer or other conditions affecting the lower digestive tract, an ileostomy may have b...

29/03/2025

Congratulations, Dr. Winkle Jones Alkuino!

08/03/2025

08/03/2025

More About Gallstones: Are You at Risk?

Curious about what causes gallstones and how to prevent them? Discover the key risk factors and simple tips to protect your health! 👇

Consult your Gastroenterologist to know more!🩺

Please follow, like, and share
🌐Visit our website: psgastro.org
✉️ Email us at: philgastro60@gmail.com

-iwas

08/03/2025

30/01/2025

Thank you for teaching us, Dr. Faylona!

22/01/2025

30/10/2024

24/10/2024

In honor of Breast Cancer Awareness Month, JCI Boholana Kisses is excited to present "𝐆𝐑𝐎𝐎𝐕𝐄 𝐅𝐎𝐑 𝐓𝐇𝐄 𝐁𝐎𝐎𝐁: Year 2", a Zumba Fitness Party fundraiser supporting BOHOL CARES, a cancer rehabilitation and support group.

This event isn’t just about raising funds, it’s about raising awareness. Alongside the Zumba party, there will be a Breast Cancer Awareness Talk and FREE Breast Screening to help educate and empower everyone to take charge of their breast health, while also supporting those affected by breast cancer.

Every bit of support counts, and your participation—no matter how big or small—makes a real difference in the fight against breast cancer.

Join us in your best PINK outfit, and let's make an impact together!

07/07/2024

To God be the Glory!

12/02/2024

INTRAVENOUS FLUID THERAPY : Perioperative and Critical Care Setting

IV stages to check for IVF Therapy Appropriateness
I. ASSESSMENT
- Fluid balance daily
- Patient’s weight q3 days
- Fluid and electrolyte along with BUN
- If possible Na balance should be reported

II. INDICATION
A. [ Resuscitation Phase (R) or Salvage Phase (S) ]
> 3-4cc/kg/day of balanced cystralloids
> Fluid responsiveness assessment (Passive Leg Raise or End-expiratory occlusion test, MAP and cardiac output continuous monitoring via pulses contour monitor analysis allowing assessment of beat-to-beat combination)
> Patient should be reassessed after 30minutes every resuscitation
> Care should be upgraded if more than 2L of crystalloids given and still need resuscitation
> f still not given >2L of crystalloids, give 2-4cc/kg and reassess.
> GOAL: Fluid Balance must be POSITIVE

B. [ Optimization Phase (O) ]
> Starts the no overt absolute/relative hypovolemia but still unstable
> Goal: optimize and prevention of hypoperfusion (Markers: Lactate, Prolonged CRT, and Mottling Score
> Maintenance
- 25-30cc/kg/day (1cc/kg/h) of water +
- 1mmol/kg/day K + 1-1.5mmol/kg/day Na + 1mmol/kg/day Cl + 50-100g/kg/day glucose to limit starvation ketosis
- The amount of fluid intake via other sources should be subtracted from the basic maintenance need of 1cc/kg/hr (Enteral / Fluid creep)

C. [ Stabilization Phase (S)]
> To ensure water and electrolytes to replace ongoing losses and provide organ support
> Goal: ZERO or slightly negative fluid balance
> Late conservative fluid management = 2 consecutive days of negative fluid balance within the first week of ICU stay, and is an independent predictor of survival in ICU patients
> Fluid creep
- All sources should be detailed and precise
- The sum of volumes of these electrolytes + small volumes to keep venous lines open + volume for medication vehicle (1cc/kg/hr)

D. [ Evacuation Phase (E) or De-escalation Phase (D) ]
> purpose of removing excessive fluid; spontaneous diuresis

> 5 steps of Deresuscitation/DeEscalation need to be kept in mind:
1. define a clinical end- point (e.g., improvement in oxygenation);
2. set a fluid balance goal (e.g., 1 L negative balance in 24 h);
3. set perfusion and renal safety precautions (e.g., vasopressor need, 25% serum creatinine increase);
4. re-evaluate after 24 h unless safety limits reached;
5. adjust the plan accordingly.

> Management:
1. Administration of albumin in combination with diuretics (20% albumin to achieve a serum albumin levels of 30 g/L and furosemide bolus of 60 mg followed by continuous infusion of 10 mg/h)
2. PEEP application to counteract intraabdominal pressure
3. CRRT adnd aggressive ultrafiltration – to achieve negative balance

III. PRESCRIPTION
- Type, Rate, Dose, Current electrolytes disorder

IV. MANAGEMENT
- IVF Management Plan for 24hours