Hypovolemia treatment

FIGURE 10-4. Treatment algorithm for the management of moderate to severe hypovolemia. BP, blood pressure CVP, central venous pressure ECG, electrocardiogram MAP, mean arterial pressure PA, pulmonary artery PAOP, pulmonary artery occlusion pressure PRBCs, packed red blood cells SBP, systolic blood pressure. 

SuccessM treatment of PEA and asystole depends almost entirely on diagnosis of the underlying cause. Potentially reversible causes include (1) hypovolemia, (2) hypoxia, (3) preexisting acidosis, (4) hyperkalemia, (5) hypothermia, (6) hypoglycemia, (7) drug overdose, (8) cardiac tamponade, (9) tension pneumothorax, (10) coronary thrombosis, (11) pulmonary thrombosis, and (12) trauma. 

Direct measures (e.g., treatment of pain, hypovolemia, fever, infection, or salicylate overdose) can be effective. A rebreathing device (e.g., paper bag) can help control hyperventilation. 

Shock is a complex acute cardiovascular syndrome that results in a critical reduction in perfusion of vital tissues and a wide range of systemic effects. Shock is usually associated with hypotension, an altered mental state, oliguria, and metabolic acidosis. If untreated, shock usually progresses to a refractory deteriorating state and death. The three major mechanisms responsible for shock are hypovolemia, cardiac insufficiency, and altered vascular resistance. Volume replacement and treatment of the underlying disease are the mainstays of the treatment of shock. Although sympathomimetic drugs have been used in the treatment of virtually all forms of shock, their efficacy is unclear. 

In clinical practice, nephrotic edema may be further worsened by inadequate diuretic treatment resulting in temporary intravascular hypovolemia and/or by... 

In the patient with contact lenses, it is advised not to use diclofenac preparations for ophthalamic treatment. Diclofenac also is contraindicated for intravenous administration in patients with renal impairment, hypovolemia, dehydration, asthma, or cerebrovascular bleeding. 

Other treatment evacuation, decontamination, 100% O2, and correction of acidosis, hypovolemia, and seizures... 

In July 1998, The Cochrane Injuries Group Albumin Reviewers published a meta-analysis comparing the use of albumin with the use of crystalloids or no treatment in critically ill patients (12). The review was based on 30 randomized, controlled studies, involving a total of 1419 patients with hypovolemia due to trauma, surgery, burns, or hypoalbuminemia. There was excess mortality in the albumin group of about 6%, and the authors concluded that albumin should not be used outside rigorously conducted randomized controlled trials. The review elicited numerous mostly critical comments. For example, it was commented that a meta-analysis is not exact and that in this specific studythe study had conflated three separate indications that were not comparable (5). 

Acute ciclosporin-induced nephrotoxicity, causing reduced renal function, develops within the first month, and includes a dose-related rise in serum creatinine concentrations and hyperkalemia. Fatal acute tubular necrosis has also been noted after very high intravenous doses (SEDA-19, 345). Although it is clinically often difficult to differentiate from acute allograft rejection in renal transplant patients, the alteration in renal function promptly resolves on ciclosporin withdrawal or dosage reduction, and initial acute renal insufficiency is not clearly associated with the development of subsequent chronic renal dysfunction (93). Several conditions, such as pre-existing hypovolemia, concomitant diuretic treatment, or renal artery stenosis, are susceptibility factors. 

Treatment with thiazide diuretics is one of the most common causes of hyponatremia (92). Patients can present with variable hypovolemia or apparent euvolemia,... 

Although furosemide has embryotoxic properties in some animal species, it has been widely used in pregnant women without any adverse effects. Nevertheless, it should be used with great caution, since hypovolemia can lead to reduced uterine and placental blood flow. Careful monitoring of fetal heart action is necessary. Furosemide passes the placenta and increases fetal urine production. It can also increase acid concentrations in maternal serum, fetal serum, and amniotic fluid, thus masking a useful index for the development of pre-eclampsia (24). Its use in pregnant women should therefore be restricted to the treatment of cardiac failure. 

The clinical signs of hypovolemia and dehydration in the adult horse are listed in Table 17.1. Hypovolemia is defined as insufficient circulating blood volume, whereas dehydration is defined as loss of water from the tissues. It is important to distinguish between these conditions because hypovolemia requires immediate treatment but dehydration is optimally addressed over a period of 12-24 h. However, in most clinical scenarios, hypovolemia and dehydration occur concurrently. 

The resuscitation phase aims to restore circulating volume. There are two ways to think about the treatment of hypovolemia, both of which result in similar treatment patterns. Hypovolemic horses typically require 20-80 ml/kg of crystalloid fluids acutely. 

The goals in treating patients with hypernatremia include correction of the serum sodium concentration at a rate that restores and maintains cell volume as close to normal as possible, as well as normalizing the ECF volume in states of ECF volume depletion and expansion. Adequate treatment should result in the resolution of symptoms associated with hypovolemia. Careful titration of fluids and medications should minimize the adverse effects from too rapid correction. Modulation of dietary sodium intake and sodium replacement may be necessary to prevent recurrence of hypernatremia. 

Splenic sequestration crisis is a major cause of mortality in young patients with SCD. The sequestration of RBCs in the spleen may result in a rapid drop of hematocrit, leading to hypovolemia, shock, and death. Immediate treatment is red cell transfusion to correct hypovolemia. Broad-spectrum antibiotic therapy, which includes coverage for pneumococci and H. influenzae, may also be beneficial, because infection may precipitate crises. " ... 

In patients with peritonitis, hypovolemia often is accompanied by acidosis, so a reasonable IV fluid would be lactated Ringer s solution, which contains the bicarbonate precursor lactate, as well as sodium, chloride, potassium, and calcium. In the initial hour of treatment, large volumes of solution may be required to restore intravascular volume. Hours thereafter, fluids may be required at a rate of 1 L/h. Maintenance fluids should be instituted (after intravascular volume is restored) with 0.9% sodium chloride and potassium chloride (20 mEq/L) or 5% dextrose and 0.45% sodium chloride with potassium chloride (20 mEq/L). The administration rate should be based on estimated daily fluid loss through urine and nasogastric suction, including 0.5 to 1.0 L for insensible fluid loss. Potassium would not be included routinely if the patient is hyperkalemic or has renal insufficiency. 

Chapter 4 focuses on fluid volume imbalances (i.e., hypervolemia and hypovolemia) and related symptoms and treatments. Chapters 5 through 9 present the major electrolytes and concepts related to excessive or insufficient blood levels of sodium, potassium, calcium, magnesium, and phosphate. Chapter 10 focuses on acid-base imbalances and discusses the procedures needed to determine the underlying source of the imbalance and the appropriate treatments and patient care needed to address the imbalance. Chapters 11 and 12 contain presentations of developmental conditions and disease conditions that involve imbalances in fluids, electrolytes, and acid-base, with the aim of enabling the reader to apply the concepts learned in earlier chapters of the book. 

Treatment of the underlying problem is critical to resolution of hypovolemia. 

If the hypovolemia is relative and related to fluid moving into the tissues owing to a lack of protein and osmotic pressure in vessels, treatment will center on increasing protein (i.e., infusing albumin) in the blood vessels to bring volume into the blood vessels from the tissues. 

What treatment would be most appropriate for a patient with hypovolemia owing to massive sepsis ... 

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