The Choice of Fluids in Hypovolaemia

Abstract

In 1896, Starling discovered the effect that plasma proteins had on the exchange of fluid between the intravascular and extravascular spaces [1]. Some ten years prior to this, it had been realised that hypovolaemic death was due to a lack of circulating volume and not to a shortage of red cells. These two facts form the basis for the fluid therapy of hypovolaemia. More recently, refinements in treatment, such as the discovery of the ABO groups in the early 1900’s, the use of anticoagulants for the storage of blood during the 1914–1918 war, the use of gum saline and the use of alkaline gelatin, also during the 1914–1918 war were introduced. Between the two wars, blood transfusions, plasma infusions and saline were the principal replacement fluids, and then during the 1939–1945 war, the dextrans were introduced, firstly of a very high molecular weight, which was later reduced to the present medium levels of molecular weight. Polyvinylpyrrolidone was also introduced during the second world war, but has failed to stand the test of time due to problems of long-term storage in the reticulo-endothelial system. It was at this time that a renewed interest in gelatin became apparent, and polygeline was introduced, and at about the same time hydroxyethyl starch was being developed. More recently still have been two further developments, namely stroma-free haemoglobin and fluorocarbon emulsions, both designed to be oxygen-carrying solutions.