- an adequate and timely replacement of actual losses with appropriate preparations seems to be an ideal primary approach
- we should divide fluid therapy into two components:
- replacement of fluid losses from the body via insensible perspiration (~500mL/24h), bowel motions (~200mL/24h) and urinary output (500-2000 mL/24h) and
- replacement of plasma losses from the circulation due to fluid shifting or acute bleeding
- While a goal-directed approach via circulatory surrogates is, in principle, possible to replace plasma losses, the extracellular compartment cannot currently be monitored
RULES OF THUMB
- the extracellular deficit after usual fast is low
- use crystalloid only for insensible losses and urine output
- Insensible losses =0.5 ml/kg/hr or 1 ml/kg/hr if the abdomen is open
- primarily fluid-consuming third space does not exist
- replace circulatory plasma loss with iso-oncotic colloid (e.g. 4% albumin)
References and Links
- Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. 2008 Oct;109(4):723-40. PMID: 18813052.
- Hilton AK, Pellegrino VA, Scheinkestel CD. Avoiding common problems associated with intravenous fluid therapy. Med J Aust. 2008 Nov 3;189(9):509-13. PMID: 18976194.
- Mac Sweeney R, et al. Perioperative Intravenous Fluid Therapy for Adults Ulster Med J 2013;82(3):171-178 [Free Full Text]