Abstract
Fluid deficits and electrolyte imbalances are common among surgical, traumatised and intensive care unit (ICU) patients. Fluid deficits can occur in the absence of obvious fluid loss secondary to vasodilation or generalised alterations of the endothelial barrier resulting in diffuse capillary leak. Thus, especially in the inflammatory patient, large fluid deficits become obvious. This situation is characterised by panendothelial injury with subsequent development of increased endothelial permeability, leading to a loss of proteins and a fluid shift from the intravascular to the interstitial compartment and resulting in interstitial oedema. Fluid deficits (or overload) are often associated with compromised acid-base status and electrolyte imbalance (Fig. 1).
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References
Smith HS, Lumb PD (1997) Perioperative management of fluid and blood replacement. In: McLeskey CH (ed) Geriatric Anesthesiology. Williams & Wilkins, Baltimore, pp 13–28
Jin F, Chung F (2001) Minimizing perioperative adverse events in the elderly. Br J Anaesth 87:608–624
Oskvig RM (1999) Special problems in the elderly. Chest 115:158S–164S
Priebe HJ (2000) The aged cardiovascular risk patient. Br J Anaesth 85:763–778
Vaupshas HJ, Levy M (1990) Distribution of saline following acute volume loading: postural effects. Clin Invest Med 13:165–177
Funk W, Baldinger V (1995) Microcirculatory perfusion during volume therapy. A comparative study using crystalloid or colloid in awake animals. Anesthesiology 82:975–982
Prien T, Backhaus N, Pelster F et al (1990) Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. J Clin Anesth 2:317–323
Schött U, Lindbom LO, Sjöstrand U (1988) Hemodynamic effects of colloid concentration in experimental hemorrhage: a comparison of Ringer’s acetate, 3% dextran-60 and 6% dextran-70. Crit Care Med 16:346–352
Ruttmann TG, James MFM, Finlayson J (2002) Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery. Br J Anaesth 89:226–230
Ruttmann TG, James MFM, Lombard EM (2001) Haemodilution-induced enhancement of coagulation is attenuated in vitro by restoring antithrombin III to predilution concentrations. Anaesth Intensive Care 29:489–493
Ng KFJ, Lam CCK, Chan LC (2002) In vivo effect of haemodilution with saline on coagulation: a randomized controlled trial. Br J Anaesth 88:475–480
Boldt J, Haisch G, Suttner S et al (2002) Are lactated Ringer’s solution and normal saline solution equal with regard to coagulation? Anesth Analg 94:378–384
Janvrin SB, Davies G, Greenhalgh RM (1980) Postoperative deep vein thrombosis caused by intravenous fluids during surgery. Br J Surg 67:690–693
Prough DS (2000) Acidosis associated with perioperative saline administration. Anesthesiology 93:1184–1187
Kellum JA (2002) Saline-induced hyperchloremic metabolic acidosis. Crit Care Med 30:259–261
Takil A, Eti Z, Irmak P et al (2002) Early postoperative respiratory acidosis after large intravascular volume infusion of lactated Ringer’s solution during major surgery. Anesth Analg 95:294–298
Rehm M, Orth V, Scheingraber S et al (2000) Acid-base changes cause by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution. Anesthesiology 93:1174–1183
Waters JH, Bernstein CA (2000) Dilutional acidosis following hetastarch or albumin in healthy volunteers. Anesthesiology 93:1184–1187
Waters JH, Gottlieb A, Schoenwald P et al (2001) Normal saline versus Ringer’s lactate solutions for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg 93:817–822
Wilkes NJ, Woolf R, Mutch M et al (2001) The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 93:811–816
Wilcox CS (1983) Regulation of renal blood flow by plasma chloride. J Clin Invest 71:726–735
Bennett-Guerrero H, Manspeizer RJ, Frumento B et al (2001) Impact of normal saline-based versus balanced salt fluid replacement on postoperative renal function: randomized trial. Preliminary results. Anesth Analg 92:A129
Boldt J, Schöllhorn T, Schulte G et al (2006) A total balanced volume replacement strategy using a new balanced hydroxyethyl starch preparation (6% HES 130/0.42) in patients undergoing major abdominal surgery. Eur J Anaesthesiol (in press)
Mythen MG, Webb AR (1994) The role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. Intensive Care Med 20:203–209
Takala J (1994) Splanchnic perfusion in shock. Intensive Care Med 20:403–404
Bams JL, Mariani MA, Groneveld ABJ (1999) Predicting outcome after cardiac surgery: comparison of global haemodynamic and tonometric variables. Br J Anaesth 82:33–37
Vermeulen LC, Ratko MA, Estad BL et al (1995) A paradigm for consensus—the university hospital consortium guidelines for the use of albumin, nonprotein colloids, and crystalloid solutions. Arch Intern Med 155:373–379
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Boldt, J. (2007). Fluid and electrolyte emergency. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-0571-6_9
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DOI: https://doi.org/10.1007/978-88-470-0571-6_9
Publisher Name: Springer, Milano
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