Fluid resuscitation
Is like baking a cake.
Alexander Hossain 2019
Flour isn’t binding together (patient is dry)
• Low BP/tachycardia
• *may not be tachy if on Ca inhibitors or beta blockers
• Thirst
• *older people due to ADH insensitivity may have decreased thirst drive and
response to heath
• Dry mucous membranes
• Low urine output
• Weight loss
• Headache
Alexander Hossain 2019
Effective circulatory volume…
…Is dependent on
…Is reduced when
…Is rectified by
Volume
GI losses, haemorrhage, burns,
polyuria, third spacing, or no
intake
FLUID REPLACEMENT
Cardiac output
Heart failure, cardiogenic shock
Positive inotropes (e.g. digoxin);
correction of cause
Vascular resistance
Septic shock, anaphylactic shock
Antibiotics, adrenaline; again,
treat the cause
Loss of ECV = circulatory failure = haemodynamic instability = shock = low BP
Alexander Hossain 2019
circulatory collapse
shock
Alexander Hossain 2019
And we don’t want this
Low BP = poor tissue perfusion = ischaemia to everything
And electrolyte disturbances can do bad things too (listen to your VBG)
Prompt volume resuscitation is necessary to:
• Restore vascular volume and normalise venous return, cardiac
output, and blood pressure
Alexander Hossain 2019
Principles of fluid resuscitation
1. Sodium remains in ECV
2. Water follows osmols
We therefore give saline that is iso-osmotic*…
• To increase intravascular volume
• To prevent fluid shifts between compartments
*plasma is 300mOsm; 150mmol/L of NaCl is also 300mOsm = 0.9% NaCl
Alexander Hossain 2019
What give?
• Correct the volume issue
• Correct the electrolyte issue
• Porque no los dos?
• And treat the issue!
• DKA
• Sepsis
• Haemorrhage
Alexander Hossain 2019
What is
Alexander Hossain 2019
Crystalloid or colloid?
Alexander Hossain 2019
How much and how fast?
• As much as you think is necessary
• As fast as you think is necessary:
• 500ml bolus over less than 15 minutes
• Can use the pumpy thing
Alexander Hossain 2019
And then what?
• Review
• Give another bolus
• At 2000ml
• Seek expert help
Alexander Hossain 2019
Caveats
• Isotonic saline can cause metabolic acidosis
Alexander Hossain 2019