Format

Send to:

Choose Destination
See comment in PubMed Commons below
Emerg Med J. 2003 Jul;20(4):306-15.

Salt of the earth or a drop in the ocean? A pathophysiological approach to fluid resuscitation.

Author information

  • 1Department, Selly Oak Hospital University Hospital Birmingham NHS Trust, Raddlebarn Road, Birmingham B29 6LD, UK. Peter.Gosling@uhb.nhs.uk

Abstract

The evolved endocrine response after injury leads to sodium, chloride, and water retention at a time when large volumes of sodium containing fluids are given to maintain the circulation and preserve tissue oxygenation. Sodium, chloride, and water are also retained because of increased systemic vascular permeability to plasma proteins, especially albumin, which sequesters fluid in the interstitial space and causes oedema. Excessive fluid and electrolyte retention and interstitial oedema are associated with the systemic inflammatory response syndrome and multiple organ dysfunction, and failure. This review attempts an overview of these processes and addresses the question, "Can manipulation of fluid resuscitation influence the inflammatory response to injury and organ function". Results of randomised controlled prospective clinical studies suggest that limiting the sodium and chloride input and optimal use of synthetic colloids, which are well retained in the vascular space, can reduce the inflammatory response to injury and improve organ function.

PMID:
12835337
[PubMed - indexed for MEDLINE]
PMCID:
PMC1726159
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk