The Effects of Large Intravenous Infusions on Body Fluid 1

Abstract

Much consideration has been given to the changes which result in man and in experimental animals from administering by vein various quantities of fluids of different composition (1, 2, 3). Thus, the dislocation of body fluid and the urinary changes which follow rapid infusion of massive quantities of fluid in animals have been described (4,5,6). Shifts of water and salts between muscle and blood after infusion of isotonic fluids of varying pH have been studied in dogs by means of muscle biopsy and analysis (7). The circulatory effects of administering fluid by vein in various clinical conditions have been investigated, having in mind the primary importance of circulatory dynamics in determining response to intravenous fluid therapy (1,8). Such studies have served to emphasize the fundamental conclusions of Gamble (9, 10, 11), Peters (12, 13), and others.In the work on which the present report is based it seemed desirable to determine the results of large amounts of isotonic glucose and NaCl solutions administered by constant intravenous drip over a period of several days. The physiological responses to sustained submaximal infusions were under inquiry rather than the reaction to a large or small intravenous injection of brief duration, for it seemed possible that compensatory mechanisms of a different nature might be brought into play as the infusions were continued. MATERIAL AND METHODSPatients undergoing mild or moderately severe operations under ether anesthesia were studied just before operation, just after operation, at the end of the infusion period, and several days afterwards when the effects of the infusion had subsided. Determinations were made on a fasting basis, and the patients took water as desired during the infusion period but were allowed only small amounts of fruit juices in addition. The patients 'Aided by grants from the William F. Milton Fund, Harvard University, and the Josiah Macy, Jr. Foundation.were well-nourished women without cardiovascular or renal disease. During the study they were under constant observation by trained attendants and, if a patient objected, the infusion was discontinued. Urine was collected quantitatively by an indwelling catheter. Arm or leg veins were used for the infusion, the extremity being splinted, and except for slight redness about the needle in two or three instances no local reaction was noted. The patients were entirely afebrile, or nearly so, during the study. Intake of fluid by oral and intravenous routes and output of urine were totaled at 12-hour intervals. Four patients received 5 per cent glucose solution and six 0.9 per cent NaCl solution.

Blood Volume and Sodium Retention in the Nephrotic Syndrome: A Controversial Pathophysiological Concept

“…This point is reached when ECF is increased by 40% and BV by 25% [77]. A similar degree of BV expansion has been reported in patients with acute glomerulonephritis [34] and also in overexpanded postoperative patients [103].…”

The Treatment of Shock Due to Salt Depletion; Comparison of the Hemodynamic Effects of Isotonic Saline, of Hypertonic Saline, and of Isotonic Glucose Solutions 12

“…These changes accompany a restoration of normal tonicity to body fluids, a reexpansion of extracellular fluid, and a contraction of the overexpanded intracellular fluid. These observations are consistent with the few clinical observations available on the admninistration of saline intravenously to patients depleted of salt (2,3). It should be noted that studies of the effects of saline by various routes on the circulation in normal subjects are not directly pertinent (4 to 8).…”

Alterations of Fluid and Electrolyte Distribution and Renal Function in Diarrhea of Infancy 1

“…That a load of extracellular electrolyte may be excreted only after a delay of 24 to 36 hours in the normal infant and adult has been repeatedly demonstrated (34)(35)(36)(37)(38). Indeed, a normal infant may retain saline given subcutaneously for as long as five days (39).…”