Intravenous fluid therapy in adult inpatients

Frost, Paul

doi:10.1136/bmj.g7620

Cited by 35 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An important clinical implication from our observations concerns the strong preference within clinical medicine for sodium‐based intravenous fluids over EFW solutions, such as glucose 5%, as the former are considered to expand ECV without significant expansion of ICV as compared to EFW solutions (Rose ; Guyton ; Frost ). Large infusions of sodium‐based fluids frequently lead to sodium accumulation and hypernatremia in patients.…”

Section: Discussionmentioning

confidence: 93%

“…Although major textbooks on physiology (Guyton ) and electrolyte and water pathophysiology (Rose ) and a recent review (Frost ) claim that EFW distributes proportionally over the ICV and ECV (Fig. A–D), this concept has not been verified in critically ill patients who require extensive IV fluid administration in the context of a systemic inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

“…In clinical medicine, the conventional model on water and electrolyte distribution states that infused electrolyte‐free water (EFW) distributes proportionally over both the intracellular volume (ICV) and the extracellular volume (ECV) (Rose ; Guyton ; Frost ). The major cations of the ICV and ECV are potassium and sodium, respectively.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Postoperative fluid retention after heart surgery is accompanied by a strongly positive sodium balance and a negative potassium balance

et al. 2016

View full text Add to dashboard Cite

The conventional model on the distribution of electrolyte infusions states that water will distribute proportionally over both the intracellular (ICV) and extracellular (ECV) volumes, while potassium homes to the ICV and sodium to the ECV. Therefore, total body potassium is the most accurate measure of ICV and thus potassium balances can be used to quantify changes in ICV. In cardiothoracic patients admitted to the ICU we performed complementary balance studies to measure changes in ICV and ECV. In 39 patients, fluid, sodium, potassium, and electrolyte‐free water (EFW) balances were determined to detect changes in ICV and ECV. Cumulatively over 4 days, these patients received a mean ± SE infusion of 14.0 ± 0.6 L containing 1465 ± 79 mmol sodium, 196 ± 11 mmol potassium and 2.1 ± 0.1 L EFW. This resulted in strongly positive fluid (4.0 ± 0.6 L) and sodium (814 ± 75 mmol) balances but in negative potassium (−101 ± 14 mmol) and EFW (−1.1 ± 0.2 L) balances. We subsequently compared potassium balances (528 patients) and fluid balances (117 patients) between patients who were assigned to either a 4.0 or 4.5 mmol/L blood potassium target. Although fluid balances were similar in both groups, the additionally administered potassium (76 ± 23 mmol) in the higher target group was fully excreted by the kidneys (70 ± 23 mmol). These findings indicate that even in the context of rapid and profound volume expansion neither water nor potassium moves into the ICV.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Postoperative fluid retention after heart surgery is accompanied by a strongly positive sodium balance and a negative potassium balance

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Fluid infusions must be also considered as any other pharmacological therapy: they can obviously improve outcomes when accurately provided, but they can cause potentially dangerous side effects as well [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Blood Volume Determination Through New Generation 130/0,4 Hydroxyethyl-Starch: A Propaedeutic, In-Vitro Study

Girolamo¹,

Trevisan²,

Resta³

et al. 2015

Pharm Anal Acta

View full text Add to dashboard Cite

Background: The importance of knowing the blood volume, in critically ill patients, collides with the difficulty to have its direct measure through a safe and economic method. Hydroxyethyl starch (HES) was introduced by Tschaikowsky as a useful marker for the dilution method, calculating the HES concentration (HESC) in a solution by inducing an in-vitro hydrolysis of starch molecules into glucose monomers and dosing the consequent increase of the solution glucose level (Δ GLUCOSE).Objective: This study develops a simple and cheap laboratory technique which uses a new generation 6% 130/0,4 Hydroxyethyl starch as a possible "dilution marker" for the measurement of patient's blood volume maintaining Tschaikowsky's study protocol. The aim is to refocus attention on an interesting method that could lead the way to a number of possibilities in critical area. Method:We designed a two-phase in-vitro experiment. Firstly, we found out the suitable treatment duration to ensure a complete hydrolysis of starch molecules. Secondly, we aimed to the achievement of a univocal constant of proportionality (K) between Δ GLUCOSE and HES concentration. HESC will be expressed as HESV/PV (μl/mL) where HESV represents the HES volume and PV the plasma volume. Plasma volumes were calculated as BV*(1-Ht).Results: K was planned by means of a linear regression analysis between HESV/PV and Δ GLUCOSE on 133 validated samples collected from 30 healthy volunteers. The obtained hematocrit values ranged between 39.9 and 48 (mean ± CI 95%=42,62 ± 2,93). This corresponded to HESC ranging from 0,033 to 0,038 HES (mL)/PV (mL) (mean ± CI 95%=0,035 ± 0,002). While hydrolysis times increase, glucose values tended to augment until they reached stable plateau. During the second phase we handled a total of 720 specimens. Hematocrit of collected samples ranged from 33,9 to 49 (mean ± CI 95%=41,3 ± 1,21). HESC ranged between 0,015 and 0,089 mL HES/mL PV (mean ± CI 95%=0,037 ± 0,003). The regression analysis showed that HESC equals 0,592 times Δ GLUCOSE (R2=0,947). Conclusion:This study might be the first step in reintroducing starches into the clinical management of critical patients, not just as therapeutic agents for volume resuscitation but even as useful markers in the diagnosis of hemodynamic derangements, improving fluid and blood therapy strategies.

show abstract

“…Such features are well described; 7 however, none are specific to volume status 8 and many are not easy to assess. 9 A recent systematic review of 30 studies found that clinical features (including hypotension and tachycardia) were not reliable predictors of hypovolaemia.…”

Section: Introductionmentioning

confidence: 99%

What is the evidence base for fluid resuscitation in acute medicine?

Seccombe

Sapey

2018

Clinical Medicine

View full text Add to dashboard Cite

Intravenous fl uids are commonly prescribed but uncertainty remains about how to assess when fl uids are required and how much to give, particularly in our multimorbid, polymedicated and ageing population. Furthermore, studies have noted that fl uid resuscitation can be harmful even if clinical evidence of hypervolaemia is not present. Two recent guidelines have acknowledged a limited evidence base to guide fl uid assessment. A recommended means to assess hypovolaemia includes assessment of fl uid responsiveness. Fluid responsiveness is a rise in stroke volume following an increase in preload, achieved using a fl uid challenge or a passive leg raise. However, the means of defi ning fl uid responsiveness and its ability to identify patients who would benefi t from fl uid resuscitation is currently unclear. This review discusses the current guidelines about, and the evidence base for the provision of, intravenous fl uids in the acutely unwell medical patient. It highlights how little evidence is available to guide medical practice.

show abstract

Intravenous fluid therapy in adult inpatients

Cited by 35 publications

References 22 publications

Postoperative fluid retention after heart surgery is accompanied by a strongly positive sodium balance and a negative potassium balance

Postoperative fluid retention after heart surgery is accompanied by a strongly positive sodium balance and a negative potassium balance

Blood Volume Determination Through New Generation 130/0,4 Hydroxyethyl-Starch: A Propaedeutic, In-Vitro Study

What is the evidence base for fluid resuscitation in acute medicine?

Contact Info

Product

Resources

About