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Fluid Management and Electrolyte Balance

  • Felice Eugenio Agrò
  • Marialuisa Vennari
  • Maria Benedetto
Chapter

Abstract

Cardiac surgery is responsible for profound modification in body water distribution, electrolyte plasma concentration, and acid-base balance. Maintaining homeostasis must take into account the kind of surgery, the alterations due to anesthesia, the effects of cardiopulmonary bypass, patient’s comorbidities, and his own response to surgical stress. The ideal approach to perioperative fluid management is still debated in all clinical contest and in cardiac surgery patients in particular, since a load of fluid is generally needed because of cardiopulmonary bypass priming. The debate involves the kind of fluid to use (crystalloids vs. colloids, colloid vs. colloid, balanced vs. unbalance solutions) and the amount of fluid to administer (liberal, restrictive, goal-directed therapy). In this debate economics interests have influenced literature productions and results, leading more difficult the interpretation of many results and complicating clinical application of scientific founds in routinely practice. Electrolytes are always modified after cardiac surgery. With respect to the past, the benefit of their administration (in particular calcium) has been discussed in literature. In this chapter the basis of fluid and electrolyte management in cardiac surgery patient is explained, through understanding physiology and pathophysiology and considering with critical approach literature evidences.

Keywords

Physiology of body fluids Ionic balance Sodium Potassium Calcium Magnesium Chloride Bicarbonate Osmolar balance Fluid movement through capillary membranes Basis of pathophysiology of fluid and electrolyte in the postoperative ICU setting of cardiac surgery Water distribution modification Electrolyte modifications Clinical management of fluid Which kind of fluid? Physical and chemical properties Crystalloids Classification Pharmacokinetics: distribution and duration of action Normal saline solution Ringer’s lactate and Ringer’s acetate Latest-generation crystalloids Potential risks and side effects Water distribution modification Electrolyte modifications Clotting disorders Hypertonic crystalloids Colloids Physiological properties of the main colloids Pharmacokinetics: distribution and duration of action Natural colloids: albumin (HA) Composition and concentration Pharmacokinetics: distribution, elimination, and duration of action Potential risks and side effects Synthetic colloids Dextrans Pharmacokinetics: distribution, elimination, and duration of action Potential risks and side effects Gelatins Pharmacokinetics: distribution, elimination, and duration of effect Potential risks and side effects Hydroxyethyl starches Pharmacokinetics: distribution, elimination, and duration of action Potential risks and side effects Coagulation and platelet function Kidney dysfunction Anaphylaxis Storing and itching Hypertonic colloid solutions Comparison between crystalloids and colloids Comparison between HES and other colloids Comparison between balanced and unbalanced solutions Liberal vs. restricted approach Goal-directed fluid therapy Clinical impact in cardiac surgery patients Electrolyte management Sodium Potassium Calcium Magnesium 

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Felice Eugenio Agrò
    • 1
  • Marialuisa Vennari
    • 1
  • Maria Benedetto
    • 1
  1. 1.Intensive Care and Pain Management DepartmentUniversity School of Medicine Campus Bio-Medico of RomeRomeItaly

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