Intraoperative Fluid Management

  • M. Rehm
  • U. Finsterer
Conference paper


In the perioperative period, large volumes of intravenous infusions (crystalloids and colloids) are often administered to compensate for major surgical blood losses. The occurrence of metabolic acidosis due to administered intravenous infusion solutions has been known since at least the 1940s [1, 2]. To date, however, there is an ongoing controversy about the causes for this acidosis. Advocates of the ’classical’ approach, according to Siggaard- Andersen [3], favor the dilution hypothesis, which was originally proposed by Peters and van Slyke in 1946 [2]. This implies the dilution of the entire extracellular volume (ECV) with different electrolyte solutions that are free of bicarbonate. Since 1983, however, an alternative approach can be used to explain this form of a metabolic acidosis [4]. Stewart’s quantitative approach [4], which is discussed in detail elsewhere [5], defines paCO2, strong ion difference (SID), and the sum of all anionic charges of weak plasma acids ([ATOT]) as independent pH-regulating variables, whereas pH and bicarbonate (Bic) are dependent variables [4]. Stewart’s algorithms explain that a decrease in SID or an increase in [Prot ] will result in a decrease in pH (and vice versa) [4]. Recently, this approach has received much attention mainly because it explains the whole mystery of acid-base chemistry in a relatively simple quantitative manner [6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. Advocates of the Stewart approach argue that the reason for a metabolic acidosis after the administration of intravenous infusions is not the dilution of Bic but the infusion of strong anions.


Metabolic Acidosis Saline Group Crystalloid Solution Crystalloid Infusion Acute Normovolemic Hemodilution 
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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • M. Rehm
    • 1
  • U. Finsterer
    • 1
  1. 1.Department of AnaesthesiologyLudwig-Maximilians UniversityMunichGermany

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