Fluid resuscitation

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. 

For patients with fluid deficits, it is safer and more cost-effective to correct fluid abnormalities using standard intravenous fluids (e.g., sodium chloride 0.9% in water, dextrose 5% in water, and lactated Ringer s solution). Minimizing fluid volume in PN may be indicated in patients with fluid overload, such as critically ill patients who receive large-volume resuscitation fluids, patients with oliguric (urine output less than 400 mL/day) or anuric (urine output less than 50 mL/day) renal failure, and those with congestive heart failure. It is reasonable to... 

Colloids Resuscitation fluids that restore and/or increase the intravascular oncotic pressure. 

Crystalloids Resuscitation fluids that are composed of dissolved electrolytes. 

Very promising preliminary results have also been obtained in various types of shock the perfusion of IPS 200 (the lyophilized Ginkgo extract for parental use) in patients suffering from Atkinson s syndrome (monoclonal gammapathy) led to a very significant improvement in the clinical outcome with normalization of the respiratory functions and decreased requirement of resuscitative fluid [188],... 

Spatial separation of hemoglobin confers many desirable properties to the LEH. Yet, like other hemoglobin-based oxygen carriers, it is not a complete resuscitation fluid for hypovolemic shock. Intervention in severe hemorrhage... 

Rabinovici R, Rudolph A8, Vernick J, et al. A new salutary resuscitative fluid liposome encapsulated hemoglobin/hypertonic saline solution. J Trauma 1993 35 121. 

Rudolph AS, Cliff RO, Klipper R, et al. Circulation persistence and biodistribution of lyophilized liposome-encapsulated hemoglobin an oxygen-carrying resuscitative fluid. Crit Care Med 1994 22 142. 

Evans PA, Glenn JR, Heptinstall S, Madira W. Effects of gelatin-based resuscitation fluids on platelet aggregration. Br J Anaesth 1998 81 198-202. 

Two classes of polyionic fluid are available, those for resuscitation and those for maintenance. Maintenance fluids (Normosol-M), Plasma-lyte M, Plasmalyte-56, contain higher potassium (15-30 mEq/1 (15-30 mmol/1)) and lower sodium (40-60 mEq/1 (40-60 mmol/1)) and chloride (40-60 mEq/1 (40-60 mmol/1)) concentrations than resuscitation fluids (Normosol-R), Plasma-lyte 148, Isolec, lactated Ringer s solution. Currently, maintenance fluids are not available commercially in volumes of greater than 1 liter, which has led to the practice of adding potassium chloride (at 10-20 mEq/1) to resuscitation formulas so that they can be used as maintenance fluids in equine medicine. Commercial maintenance fluids should be considered as a treatment option in equine neonates. 

Isotonic (0.9%) sodium chloride is used commonly as an intraoperative intravenous (i.v.) replacement fluid in species other than the horse. Isotonic sodium chloride has a higher ratio of chloride to sodium than plasma and, therefore, reduces the strong ion difference and causes mild hyperchloremic acidosis in normal ponies (Gossett et al 1990a). This limits its utility as a resuscitation fluid in the horse, as most horses requiring fluid resuscitation already have acidosis. Isotonic sodium chloride should not be used for resuscitation unless indicated by measured electrolyte abnormalities. A possible exception is in foals with ruptured bladders, which are highly likely to be hypochloremic, hyponatremic and hyperkalemic. 

Tanaka J, Matsuda T, Miyagantani Y, et al. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration. Arch Surg 2000 135 326-331. 

Health care professionals are advised of the clear evidence of harm such as increased renal dysfxmction and mortality with the use of HES. Also, there is no evidence that HES solutions used for plasma volume expansion provide additional clinical benefits to patients when compared with crystalloids. In conclusion, an alternative resuscitation fluid should be selected for patients in accordance with clinical guidelines. 

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