Fluid therapy complications

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

The indications for pulmonary artery catheterization are controversial. Because there is a lack of a well-defined outcome of data associated with this procedure, its use is presently best reserved for complicated cases of shock not responding to conventional fluid and medication therapies. Complications related to catheter insertion, maintenance, and removal include damage to vessels and organs during insertion, arrhythmias, infections, and thromboembolic damage. 

Standard therapy Intensive care treatment and monitoring is accepted as standard therapy complications may appear unexpectedly and rapidly. In about 75% of patients with mild cholangitis, therapeutic success can be achieved by the substitution of fluid, electrolytes and zinc as well as vitamins, glucose (possibly also amino acids) and the (indispensable) administration of antibiotics. Analgesics and spasmolytics are generally necessary. In addition, the administration of fresh plasma is recommended to stabilize haemostasis. 

The IV catheter should be secured, but this is not the most important intervention because even if it is not secured the child would not experience fluid-volume overload, which is a potentially life-threatening complication of IV fluid therapy. 

Most patients with enterocolitis require no therapeutic intervention. The most important part of therapy for Salmonella enterocolitis is fluid and electrolyte replacement. Antimotility drugs should be avoided because they increase the risk of mucosal invasion and complications. 

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 ... 

Secondary ischemia is a frequent complication after SAH and is responsible for a substantial proportion of patients with poor outcome. The cause of secondary ischemia is unknown, but hypovolemia and fluid restriction are important risk factors. Hypovolemia should be avoided and intravenous fluids given, at least 3 liters per day, to reduce the likelihood of delayed ischemia. Indeed, volume expansion therapy is frequently used in patients with SAH to prevent or treat secondary ischemia. However, the risks and benefits of volume expansion therapy have been studied properly in only two trials of patients with aneurysmal SAH, with very small numbers (Rinkel et al. 2004). At present, there is no good evidence for the use of volume expansion therapy in patients with aneurysmal SAH. 

Results The results of paracentesis have generally been good up to now the number of successfully treated patients was higher, inpatient hospitalization was shorter, and complications were less frequent or less severe. The response to diuretic therapy improved considerably discontinued diuretic therapy could be successfully taken up again. (158,159) Plasma values of renin, aldosterone and norepinephrine dropped. There was an improvement in lung volume (141,143) as well as in cardiac function values. (152,153,156) The pressure in the oesophageal varices fell. (150) Paracentesis of 6 litres of ascitic fluid removes 6 X 130 mmol sodium. 

Modifled ascites Reinfusion of modified ascitic fluid calls for prior desalination or concentration with the subsequent aim of reproteinization . (173) The concentration of the reinfused protein was 4 to 6 times higher than the protein content of the ascitic fluid. Combined with a diuretic therapy, up to 13 litres of ascitic fluid were removed in 24 hours. A comparative study showed no difference in efficacy or complications between the reinfusion of unmodified and ultrafiltered ascitic fluid. 

Hemodjmamic and cardiac complications are the major limitations of high-dose aldesleukin and have been described in both adults (19,20) and children (21). Significant hypotension requiring meticulous maintenance therapy with intravenous fluids or low-dose vasopressors was observed in most patients (22). The clinical findings were very similar to the hemodynamic pattern seen in early septic shock. Aldesleukin-induced increases in plasma nitrate and nitrite concentrations correlated with the severity of hypotension (23). 

Albuterol overdoses rarely require treatment beyond gastrointestinal decontamination. Children have survived overdoses as large as 100 mg and adults have survived doses up to 240 mg without serious complications. Activated charcoal effectively adsorbs albuterol. The hypokalemia produced reflects a transient shift in potassium location rather than a true deficit of potassium external replacement therapy is rarely necessary but can be added to intravenous fluids to support the heart if electrocardiographic changes are noted. A conservative approach to tachycardia is recommended since arrhythmias beyond an increase in rate have not occurred with overdose. Support of blood pressure and control of tachycardia are major therapeutic interventions. 

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