Crystalloids adverse effects

Generally, the major adverse effects associated with colloids are fluid overload, dilutional coagulopathy, and anaphy-lactoid/anaphylactic reactions.24,32 Although derived from pooled human plasma, there is no risk of disease transmission from commercially available albumin or PPF products since they are heated and sterilized by ultrafiltration prior to distribution.24 Because of direct effects on the coagulation system with the hydroxyethyl starch and dextran products, they should be used cautiously in hemorrhagic shock patients. This is another reason why crystalloids maybe preferred in hemorrhagic shock. Furthermore, hetastarch can result in an increase in amylase not associated with pancreatitis. As such, the adverse-effect profiles of the various fluid types should also be considered when selecting a resuscitation fluid. 

The colloids, in particular albumin, are expensive solutions. Therefore, it is difficult to justify the additional cost of colloidal products unless the benefit-to-risk ratio is substantially greater than that associated with inexpensive crystalloid solutions. This does not appear to be the case based on randomized, controlled studies and meta-analyses comparing colloid and crystalloid solutions for acute circulatory insufficiency. Because other colloids, such as hetastarch, almost always have been compared with albumin and not with crystalloid solutions in published clinical studies (with no clinically important differences being found), there is no reason to suspect that these other colloids have any unique advantages as volume expanders. Adverse effects associated with colloids appear to be uncommon and generally are extensions of their pharmacologic activity (Table 24—4), but this is also true of crystalloids. The benefit-to-risk ratio appears to be similar for colloids and crystalloids thus, based on cost, crystalloids are preferred for initial treatment of circulatory insufficiency. 

Human plasma has a colloid osmotic pressure of 3.6 kPa, of which 2.8 kPa is contributed by albumin. Volume-for-volume, 4.5% albumin is approximately four times more effective in expanding the plasma volume than crystalloid solutions, and the effect lasts 6-8 hours, compared to only 15-20 min with crystalloids. Although popular in the past as volume expanders, albumin solutions have fallen into disfavour. They are prepared from pooled human plasma, with all the inherent risks of pooled blood products. Albumin can cause adverse reactions, similar to other transfusion reactions, such as chills, urticaria, and vasodilatation. These may be caused by organic or inorganic substances formed during the processing... 

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