Thread by @icmteaching

Let's talk about fluids in COVID. @iceman_ex @Wilkinsonjonny @ThinkingCC @load_dependent
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Early in the outbreak it was commonly advised to aim for a -ve fluid balance
More recently a higher than expected occurrence of AKI and RRT has been observed prompting calls for a more liberal fluid strategy.
All these miss the point about the type of fluid being administered
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Hypovolaemia (low intravascular volume) should be avoided (AKI and other organ dysfunction).
Hypervolaemia (high intravascular volume) should be avoided (AKI via venous congestion, pulmonary oedema, R heart strain and other organ dysfunction)
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Dehydration (water deficiency) should be avoided (hypernatraemia, renal injury)
Euvolaemia and normal hydration is clearly the aim.
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The vital distinction between water and salty water is not mentioned. It is difficult for the body to excrete sodium. Osmoreceptors are not activated when 0.9% saline or CSL is administered. This type of fluid will contribute to fluid overload, oedema and venous congestion
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Water will avoid dehydration (manifested most clearly by hypernatraemia) and its negative effects on the kidney. Water (without Na) does not contribute to oedema or volume overload (caused by salty water). Any excess will be excreted if the kidneys are working reasonably well
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The answer is simple for COVID-19 (and all other) patients.

Give everyone their daily requirements of water (and other electrolytes) 25-30ml/kg/day water and 1mmol/kg/day Na and K

They will probably already be exceeding their Na input from Na containing drugs
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So they just need adequate water. 25-30mls/kg/day plus any extra they might need from pyrexia/sweating etc which can be guided by Na levels. If Na goes up give enough water to make it normal again
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