Abstract
Fluid overload (FO) is characterized by hypervolemia, edema, or both. In clinical practice it is usually suspected when a patient shows evidence of pulmonary edema, peripheral edema, or body cavity effusion. FO may be a consequence of spontaneous disease, or may be a complication of intravenous fluid therapy. Most clinical studies of the association of FO with fluid therapy and risk of harm define it in terms of an increase in body weight of at least 5–10%, or a positive fluid balance of the same magnitude when fluid intake and urine output are measured. Numerous observational clinical studies in humans have demonstrated an association between FO, adverse events, and mortality, as have two retrospective observational studies in dogs and cats. The risk of FO may be minimized by limiting resuscitation fluid to the smallest amount needed to optimize cardiac output and then limiting maintenance fluid to the amount needed to replace ongoing normal and pathological losses of water and sodium.
Highlights
Fluid overload (FO) is characterized by hypervolemia, edema, or both
Evolutionary pressure likely selected for the adaptive responses to hypovolemia following injury or illness, there was no such selection pressure to respond to hypervolemia in the same setting, a situation commonly referred to as fluid overload (FO)
For many years FO has been recognized as a potential complication of anuria in chronic hemodialysis patients, in this century the phrase has more often been used to describe a complication of fluid therapy in any patient at risk for hypervolemia or edema
Summary
Fluid overload (FO) is characterized by hypervolemia, edema, or both In clinical practice it is usually suspected when a patient shows evidence of pulmonary edema, peripheral edema, or body cavity effusion. The mammalian stress response to injury, hypovolemia, or critical illness includes retention of sodium and water and, at least early on, increased thirst [1,2,3,4,5]. These responses may serve to defend blood volume and maintain hydration when access to water is impaired by debility, and in the absence of medical care likely confer some survival advantage.
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