Basic Concepts of Fluid and Electrolyte Therapy

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position to postoperative parotitis, and an increase in viscosity of pulmonary mucus resulting in mucous plug formation and ateletactasis. Induction of anaesthesia in patients with a fluid deficit further reduces the effective circulatory volume by decreasing sympathetic tone. Inadequate fluid resuscitation and decreased tissue perfusion can lead to gastrointestinal mucosal acidosis and poorer outcome. A recent meta-analysis of patients undergoing major abdominal surgery has shown that patients managed in a state of fluid and electrolyte balance had a 59% reduction in risk of developing complications when compared with patients managed in a state of fluid imbalance (deficit or excess). There was also a 3.4 day reduction in hospital stay in the fluid balance group. Moreover, maximum weight gain was seen in the studies in which the standard group received an excessive amount of fluid. It appears that patients need to gain at least 2.5-3 kg in weight, as a result of salt and water overload, in the postoperative period in order to have a worse outcome than those maintained in a state of zero fluid balance. Avoidance of fluid overload, rather than fluid restriction seems to be the key to better postoperative outcome. Moore and Shires wrote in 1967, “The objective of care is restoration to normal physiology and normal function of organs, with a normal blood volume, functional body water and electrolytes. This can never be achieved by inundation.” This recommendation has never been bettered. 120
Selected References The list of references is not exhaustive and is just a suggested list of important papers or texts for further reading. Works of particular interest have been marked with a “ * ”. 1. *Abbas SM, Hill AG. Systematic review of the literature for the use of oesophageal Doppler monitor for fluid replacement in major abdominal surgery. Anaesthesia 2008;63:44-51. 2. Allison S. Fluid, electrolytes and nutrition. Clin Med 2004;4:573-8. 3. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors Student Course Manual. 6 th edn. Chicago: American College of Surgeons, 1997. 4. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest 1999;115:1371-7. 5. Aukland K and Nicolaysen G. Interstitial fluid volume: local regulatory mechanisms. Physiol Rev 1981;61:556-643. 6. *Awad S, Allison SP, Lobo DN. The history of 0.9% saline. Clin Nutr 2008; 27:179-88. 7. Balogh Z, McKinley BA, Cocanour CS, et al. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 2003; 138:637-42; discussion 642-3. 8. Bellamy MC. Wet, dry or something else? Br J Anaesth 2006;97:755-7. 9. Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003;238:641-8. 10. Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev 2011;(3):CD001319. 11. *Bushinsky DA, Monk RD. Electrolyte quintet: Calcium. Lancet 1998;352: 306-11. 12. *Callum KG, Gray AJG, Hoile RW, et al. Extremes of Age: The 1999 Report of the National Confidential Enquiry into Perioperative Deaths. National Confidential Enquiry into Perioperative Deaths: London, 1999. 121
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electro
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Foreword This book, ‘Basic Concep
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Table of Contents 1. Normal Physiol
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ever, contains large anions such as
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Oral intake 1.5-2 L Saliva 1.5 L Ga
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Table 2: Normal maintenance require
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Kidney: this is the main organ for
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Conversely, if the intake of Na + i
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volume at all costs. It also explai
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Conclusion Appropriate fluid therap
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Intravascular fluid volume - the to
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Colloid - a fluid consisting of mic
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Base excess - Base excess is define
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Parameter Urine output Significance
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Figure 5: Example of a vital signs
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Fluid balance charts These provide
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Osmolality In the presence of AKI,
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Chloride Despite the fact that seru
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4. Properties of Intravenous Crysta
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6-12 h. The colloid should be metab
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Table 8: Advantages and disadvantag
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Plasma- Sterofundin 0.18% Plasma-Ly
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50 Patients receiving artificial nu
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Once resuscitation has been achieve
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(3) The answer to this question is
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6. Methods of Fluid Administration
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Central Modern single or multi lume
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7. Acid-Base Balance Introduction M
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vide a simple description of the mo
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change in Pco 2 = respiratory proce
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Table 15: Causes of metabolic acido
Page 69 and 70: Renal HCO 3 - loss results from re
Page 71: Mixed acid-base disorders These are
Page 74 and 75: Urine output should be interpreted
Page 76 and 77: assess clinical response to fluid i
Page 78 and 79: Oliguria following surgery 48 h and
Page 80 and 81: Definition AKI is a result of a rap
Page 82 and 83: AKI is most commonly secondary to a
Page 84 and 85: History Examination Investigations
Page 86 and 87: Management Prevention Any patient a
Page 88 and 89: if no clinical response and no pulm
Page 90 and 91: acidosis pH 7.2-7.4 - there is ver
Page 92 and 93: Referral to nephrologist NOT all p
Page 94 and 95: Follow up Acute kidney injury is a
Page 96 and 97: DKA and HONK represent the two extr
Page 98 and 99: Fluids and insulin In the absence
Page 100 and 101: Surgery in the patient with diabete
Page 102 and 103: 10 mmol/l/day. In the differential
Page 104 and 105: portionately more water is lost tha
Page 106 and 107: Hypokalaemia: a fall in serum conce
Page 108 and 109: Four common aspects of Ca 2+ disord
Page 110 and 111: Treatment depends on severity and c
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Page 114 and 115: Hypophosphataemia
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Page 118 and 119: Prolonged periods of preoperative f
Page 122 and 123: 13. *Chowdhury AH, Lobo DN. Fluids
Page 124 and 125: 42. Hussein H, Lewington A, Kanagas
Page 126 and 127: 67. *Michell AR. Diuresis and diarr
Page 128 and 129: 94. *Stewart PA. Modern quantitativ
Page 130 and 131: colloids 7, 26, 41, 42, 43 44, 45,
Page 132 and 133: intravascular compartment 20, 41, 4
Page 134 and 135: Stewart approach 63, 71 sympathetic
Page 136: Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electrolyte Therapy

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