Fluid replacement
It has been suggested that Management of dehydration be merged into this article. (Discuss) Proposed since April 2024. |
Fluid replacement | |
---|---|
Other names | Fluid resuscitation |
Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced with
By mouth
It is used around the world, but is most important in the developing world, where it saves millions of children a year from death due to diarrhea—the second leading cause of death in children under five.[2]
Intravenous
Daily requirements | |
---|---|
Water | 30 ml/kg/24 h |
Na+ | ~ 1 mmol/kg/24 h |
K+ | ~ 1 mmol/kg/24 h |
Glucose | 5 (3 to 8) g/hour |
Similar precaution should be taken in administration of resuscitation fluid as to drug prescription. Fluid replacement should be considered as part of the complex physiological in the human body. Therefore, fluid requirements should be adjusted from time to time in those who are severely ill.[3]
In severe
Fluid replacement is also indicated in fluid depletion due to hemorrhage, extensive burns and excessive sweating (as from a prolonged fever), and prolonged diarrhea (cholera).[citation needed]
During surgical procedures, fluid requirement increases by increased evaporation,
The table to the right shows daily requirements for some major fluid components. If these cannot be given enterally, they may need to be given entirely intravenously. If continued long-term (more than approx. 2 days), a more complete regimen of
Types
Resuscitation fluid can be broadly classified into: albumin solution, semisynthetic colloids, and crystalloids.[3]
The types of intravenous fluids used in fluid replacement are generally within the class of
Blood transfusion is the only approved fluid replacement capable of carrying oxygen; some oxygen-carrying blood substitutes are under development.
Plasmalyte is another isotonic crystalloid.[citation needed]
Blood products, non-blood products and combinations are used in fluid replacement, including colloid and crystalloid solutions. Colloids are increasingly used but they are more expensive than crystalloids. A systematic review found no evidence that resuscitation with colloids, instead of crystalloids, reduces the risk of death in patients with trauma or burns, or following surgery.[4]
Maintenance
Maintenance fluids are used in those who are currently normally hydrated but unable to drink enough to maintain this hydration. In children
Procedure
It is important to achieve a fluid status that is good enough to avoid low urine production. Low urine output has various limits, and varies for children, infants, and adults (see low urine production). The Parkland formula is not perfect and fluid therapy will need to be titrated to hemodynamic values and urine output.[citation needed]
The speed of fluid replacement may differ between procedures. For example, the planning of fluid replacement for burn patients is based on the Parkland formula (4mL Lactated Ringers X weight in kg X % total body surface area burned = Amount of fluid ( in ml) to give over 24 hours). The Parkland formula gives the minimum amount to be given in 24 hours. Half of the volume is given over the first eight hours after the time of the burn (not from time of admission to hospital) and the other half over the next 16 hours. In dehydration, 2/3 of the deficit may be given in 4 hours, and the rest during approximately 20 hours.[citation needed]
Clinical uses
Septic shock
Fluid replacement in patients with septic shock can be divided into four stages as shown below:
- Resuscitation phase - The goal of this phase is to correct the vasopressor have to be used. However, there is no definite timing of starting vasopressors. Initiation of vasopressors within the first hour of sepsis can lead to poor organ perfusion and poor organ function. Late initiation of vasopressor can lead to organ damage and increase the risk of death. Frequent monitoring of fluid status of the patient is required to prevent fluid overload.[10]
- Optimisation phase - In this phase, the goal is to increase the oxygen delivery to tissues in order to meet the oxygen demands of the tissues. Oxygen delivery can be improved by increasing passive leg raising test, ultrasound measurements of pulse pressure variation, stroke volume variation, and respiratory variations at superior vena cava, inferior vena cava and internal jugular vein.[10]
- Stabilisation phase - In this stage, the tissue perfusion starts to stabilise and the need of fluid or vasopressors starts reducing. Additional fluid challenges can be given only for those who are responsive. Maintenance fluid can be stopped if the perfusion status is adequate.[10]
- Evacuation phase - In this phase, the goal is to remove excessive fluids from those who achieved adequate tissue perfusion. Negative fluid balance is associated with decreased risk of death. However, there is no consensus regarding the optimal timing for fluid removal and risk of reduced perfusion following fluid removal is also inconclusive. A reasonable approach is to begin fluid restriction when the tissue perfusion is adequate, and consider diuretic treatment for those with clinical evidence of fluid overload and positive fluid balance. According to Fluid and Catheter Treatment Trial (FACTT Trial) protocol, those who with mean arterial pressure of more than 60 mmHg, vasopressor free for more than 12 hours, with adequate urine output can be given Brain natriuretic peptide can also be used to guide fluid removal.[10]
Acute kidney injury
Sepsis accounts for 50% of acute kidney injury patients in (
Surgery (perioperative fluid therapy)
Managing fluids during major surgical procedures is an important aspect of surgical care.[14] The goal of fluid therapy is to maintain fluid and electrolyte levels and restore levels that may be depleted.[14] Intravenous fluid therapy is used when a person cannot control their own fluid intake and it can also reduce nausea and vomiting.[14] Goal-directed fluid therapy is a perioperative strategy in which the person is administered fluids continuously and the amount of fluids given are based on the person's physiological and haemodynamic (blood flow) measurements.[14] A second approach to fluid management during surgical procedures is called perioperative restrictive fluid therapy, also known as near-zero or zero-balance perioperative fluid approach; this approach recommends lower amounts of fluids during surgery, replacing fluids when the person is low (basal fluid requirements) or loses fluid due to a surgical procedure or bleed.[14] The effectiveness of goal-directed fluid therapy compared to restrictive fluid therapy is not clear as evidence comparing both approaches have very low certainty.[14]
Fluid overload
Fluid overload is defined as an increase in body weight of over 10%.
Fluid overload causes cardiac dilation, which leads to increased ventricular wall stress, mitral insufficiency and leads to cardiac dysfunction. Pulmonary hypertension can lead to tricuspid insufficiency. Excess administration of fluid causes accumulation of extracellular fluid, leading to pulmonary oedema and lack of oxygen delivery to tissues. The use of mechanical ventilation in such case can cause barotrauma, infection, and oxygen toxicity, leading to acute respiratory distress syndrome.[11] Fluid overload also stretches the arterial endothelium, which causes damage to the glycocalyx, leading to capillary leakage and worsens the acute kidney injury.[15]
Other treatments
Proctoclysis, an enema, is the administration of fluid into the rectum as a hydration therapy. It is sometimes used for very ill persons with cancer.[16] The Murphy drip is a device by means of which this treatment may be performed.
See also
- Hypodermoclysis
- Intravenous therapy
- Hypovolemia
- Third spacing
- Pentastarch
- Passive leg raising test
References
- ^ "Ten Things Physicians and Patients Should Question", Choosing Wisely, American College of Emergency Physicians, October 27, 2014 [October 14, 2013], retrieved April 6, 2015, which cites:
- Hartling, L; Bellemare, S; Wiebe, N; Russell, KF; et al. (2006). "Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children". PMID 16856044.
- Hartling, L; Bellemare, S; Wiebe, N; Russell, KF; et al. (2006). "Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children".
- ISBN 9789280641912. Archived from the original(PDF) on December 8, 2017. Retrieved February 16, 2009.
- ^ PMID 24066745.
- PMID 30073665.
- PMID 25519949.
- ^ PMID 30478247.
- S2CID 245056959.
- ^ "Table: Holliday-Segar Formula for Maintenance Fluid Requirements by Weight". Merck Manuals Professional Edition. Retrieved 2021-01-12.
- ^ "Dehydration in Children - Pediatrics". Merck Manuals Professional Edition. Retrieved 2021-01-12.
- ^ PMID 26103147.
- ^ PMID 20167687.
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- ^ PMID 23265596.
- ^ PMID 31829446.
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- PMID 9601155.