Fluid management complications

Complications associated with PD include mechanical problems related to the PD catheter, metabolic problems associated with the components of the dialysate fluid, damage to the peritoneal membrane, and infections (Table 23-10). Strategies to manage infectious complications of PD are discussed below. 

The role of diuretics in the management of SVCS is controversial. While patients may derive symptomatic relief from edema, complications such as dehydration and reduced venous blood flow may exacerbate the condition. If diuretics are used, furosemide is used most frequently with diligent monitoring of the patient s fluid status and blood pressure. 

Extravasation generally is defined as leakage of intravenous fluids into the interstitial tissue. It is one of the most feared complications of the administration of cytotoxic chemotherapy. While extravasation does not cause death, significant morbidity may result from local tissue destruction, and immediate management is necessary. 

Medical Management No specific viral therapy exists so treatment is supportive only. Treat patients with uncomplicated VEE infection with analgesics to relieve headache and myalgia. Patients who develop encephalitis could require anticonvulsants and intensive care to maintain fluid and electrolyte balance, ensure adequate ventilation, and avoid complicating secondary bacterial infections. Patients should be treated in a screened room or in quarters treated with residual insecticide for at least five days after onset, or until afebrile (without fever) to foil mosquitoes since humans may remain infectious for mosquitoes for at least seventy-two hours. Isolation and qaurantine is not required. Standard Precautions should be practiced when dealing with infection control for VEE victims as shown below ... 

The aim is to induce natriuresis with consequent loss of water. Fluid restriction is unnecessary unless the plasma sodium falls below 120mmol/l. The initial management must include a diagnostic tap of the ascitic fluid as spontaneous bacterial peritonitis complicates up to 25% of patients on presentation. 

Microwave heating of crystalloid fluids has been recommended as a method of correcting hypothermia during resuscitation. Severe full-thickness bums and venous thrombosis occurred after infusion of over-heated crystalloid fluid in the management of a ruptured aortic aneurysm in a 75-year-old man (1). Measuring the temperature of the fluid before starting the infusion is necessary to avoid this complication. 

Long-term epidural catheters can be highly effective in the management of chronic pain of malignant and non-malignant origin, but they can also cause complications. Infection and extravasation of fluid to the paraspinal... 

Figure 54-17 Li ley s three-zone chart (with modification) for interpretation of amniotic fluid AA 5o. For explanation of the three zones, see text. (Modified from UleyAW. Liquor amnii analysis in the management of the pregnancy complicated by rhesus sensitization. Am J Obstet Gynecol 1961 82 1359-70.)...

Treatment of AP is aimed at relieving abdominal pain, replacing fluids, minimizing systemic complications, and preventing pancreatic necrosis and infection. Management varies depending on the severity... 

Elevations in sodium and potassium often are associated with Stages 4 and 5 CKD (see Chaps. 49 and 50). Disturbances in volume management due to CKD often occur in those with reduced levels of GFR or if structural damage is present. Other than in nephrotic syndrome, the fluid and electrolyte abnormalities of CKD can occur gradually and therefore without symptoms. Similarly to the other complications of CKD, clinicians must be aware that derangements in volume... 

The primary desired outcome in the management of OPC is a clinical cure, i.e., elimination of clinical signs and symptoms. Even when the patient is relatively asymptomatic, it is important to treat the initial episode of OPC to avoid progression to more extensive disease. In the most severe cases, the patient s quality of life may be impaired, and this may result in decreased fluid and food intake. Lack of appropriate treatment of OPC may lead to more extensive oral disease, especially in patients who are immunocompromised. The most serious complication of untreated OPC is extension of the in-... 

Noncomphance with the infusion of appropriately prescribed fluids also can lead to dehydration. Patients who have SBS complicated by a pancreatic flsmla and severe diarrhea lose considerable potassium and bicarbonate and may develop metabohc acidosis. Patients with severe diarrhea who have an intact colon wiU conserve sodium and chloride, resulting in considerable loss of potassium and bicarbonate and the development of metabolic acidosis. Quantifying fluid losses with particular attention to the sources of loss wiU aid in the acid-base management of these patients (see Chap. 51). 

After intestinal resection, the clinical course and nutritional management of SBS patients may be described in three stages, or phases. The first stage, or acute phase, occurs during the initial postoperative period. This phase lasts at least 1 week, and may continue from 3 weeks to 3 months. It is complicated by major fluid and electrolyte losses (up to 5 L/day) and the parenteral route should be used to supply nutritional needs. 

The cases of renal impairment cited emphasise the need to monitor renal function in patients on ACE inhibitors and diuretics. If increases in blood urea and creatinine occur, a dosage reduction and/or discontinuation of the diuretic and/or ACE inhibitor may be required. In a statement, the American Heart Association comments that acute renal failure complicating ACE inhibitor therapy is almost always reversible and repletion of extracellular fluid volume and discontinuation of diuretic therapy is the most efTective approach. In addition, withdrawal of interacting drugs, supportive management of fluid and electrolytes, and temporary dialysis, where indicated, are the mainstays of therapy. Combined use of ACE inhibitors, diuretics and NSAIDs may be particularly associated with an increased risk of renal failure, see ACE inhibitors + NSAIDs , p.28. 

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