Abstract
Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric overload shock type one is induced by sodium-free fluids such as glycine, glucose, mannitol and sorbitol and is characterized with acute dilutional hyponatraemia. Volumetric overload shock type 2 is induced with sodium-based fluids normal saline and plasma substitutes used for resuscitation of the critically ill and has no serological marker. It presents with the multiple vital organs dysfunction or failure syndrome or the adult respiratory distress syndrome. Hypertonic sodium is an effective treatment when given early adequately. The underlying pathophysiology is discussed. An alternative to Starling’s law for the capillary interstitial fluid transfer is given. Hydrodynamic of a porous orifice tube akin to capillary with a surrounding Chamber akin to the interstitial fluid space demonstrated a rapid dynamic magnetic field-like fluid circulation between the surrounding chamber and the lumen of the G tube that represent an adequate replacement for Starling’s law.
Highlights
Volumetric Overload Shock (VOS) is a condition caused by massive fluid infusions and is of two types: Type one (VOS1) and Type two (VOS2)
VOS2 is induced by massive infusion of sodium-based fluids such as normal saline, Ringer, Hartmann, plasma and plasma substitutes and/or blood transfusions that may complicate the therapy of VOS1
VOS2 is induced by the gain of 12 - 14 litres of sodium-based fluids when reported in Adult Respiratory Distress Syndrome (ARDS) [3]
Summary
Volumetric Overload Shock (VOS) is a condition caused by massive fluid infusions and is of two types: Type one (VOS1) and Type two (VOS2). VOS1 is induced by sodium-free fluid gain such as 1.5% Glycine used as irrigant during the Transurethral Resection of the Prostate (TURP) [1]. It has been reported with other irrigants such as Glucose, Mannitol and Sorbitol. It is known as the TURP syndrome or hyponatraemic shock [2] as Hyponatraemia (HN) is a marked serological marker for the condition. VOS2 is induced by massive infusion of sodium-based fluids such as normal saline, Ringer, Hartmann, plasma and plasma substitutes and/or blood transfusions that may complicate the therapy of VOS1. The occurrence of massive interstitial tissue oedema with congestion of vital organs, pleural and peritoneal effusion, in the presence of severe hypotension shock, casted doubt on Starling’s law!
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