Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
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13. <strong>Fluid</strong> <strong>Therapy</strong> <strong>and</strong> Outcome<br />
Intravenous fluid therapy is an integral component <strong>of</strong> perioperative<br />
care, but its practice has <strong>of</strong>ten been based on dogma rather than evidence,<br />
<strong>and</strong> patients have frequently received either too much or too<br />
little fluid. There is a relatively narrow margin <strong>of</strong> safety for perioperative<br />
fluid therapy <strong>and</strong> either too much or too little fluid <strong>and</strong> electrolyte<br />
(particularly sodium chloride) can have a negative effect on<br />
physiological processes, <strong>and</strong> be detrimental to outcome (Fig. 11). The<br />
goal <strong>of</strong> perioperative intravenous fluid therapy is, therefore, to maintain<br />
tissue perfusion <strong>and</strong> cellular oxygen delivery, while at the same<br />
time keeping the patient in a state <strong>of</strong> as near zero fluid <strong>and</strong> electrolyte<br />
balance as possible.<br />
Figure 11: The dose-response curve for fluid therapy showing the ill effects <strong>of</strong><br />
imbalance. (With permission from: Varadhan KK, Lobo DN. Perioperative<br />
fluid management in enhanced recovery. In: Francis N, et al (eds) Manual<br />
<strong>of</strong> Fast Track Recovery for Colorectal Surgery. Springer, London, 2012)<br />
Postoperative morbildity<br />
Reduced circulating<br />
blood volume<br />
Increased<br />
cardiopulmonary<br />
complications<br />
Decreased renal<br />
perfusion<br />
Altered coagulation<br />
Microcirculatory<br />
compromise<br />
Hypoaemia<br />
Release <strong>of</strong> reactive<br />
oxygen species<br />
Mitochondrial<br />
dysfunction<br />
Endothelial<br />
dysfunction<br />
Multiple organ<br />
failure<br />
Normovolaemia<br />
Hyperchloraemic acidosis<br />
Pulmonary oedema <strong>and</strong><br />
decreased gas exchange<br />
Splanchnic oedema<br />
Raised intra-abdominal<br />
pressure<br />
Decreased mesenteric <strong>and</strong><br />
renal blood flow<br />
Decreased tissue oxygenation<br />
Intramucosal acidosis<br />
Ileus<br />
Impaired wound healing<br />
Anastomotic dehiscence<br />
Decreased mobility<br />
Altered coagulation<br />
Microcirculatory compromise<br />
Reactive oxygen species<br />
Mitochondrial dysfunction<br />
Endothelial dysfunction<br />
Multiple organ failure<br />
<strong>Fluid</strong> deficit<br />
<strong>Fluid</strong> overload<br />
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