Effect Of Fluid Therapy Research Articles

The syndrome of inappropriate secretion of antidiuretic hormone and fluid restriction in meningitis--how strong is the evidence?

In patients with meningitis, fluid restriction is recommended to counter the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and to reduce cerebral oedema. However, any effects of an increased plasma level of ADH upon cerebral oedema would be due not to fluid retention but to hypoosmolality. In a literature review of fluid and electrolyte disturbances and the effect of fluid therapy in bacterial/tuberculous meningitis, the prevalence of hyponatraemia, hypoosmolality and SIADH varied considerably; apparently, non-osmotic stimuli for the secretion of ADH, e.g. intracranial hypertension and hypovolaemia, were present in most patients. Neither clinical nor experimental studies have confirmed that fluid restriction reduces the cerebral oedema in meningitis. Furthermore, compared with maintenance therapy, fluid restriction did not improve outcome in a randomized controlled study. Thus, we find no evidence to support the use of fluid restriction in patients with meningitis. Fluid therapy in acute bacterial meningitis should aim at avoiding hypovolaemia and hypoosmolality based on the assumptions that (i) ADH is increased by non-osmotic stimuli; (ii) elevated ADH is less important for cerebral oedema than severe hypoosmolality, which may in itself induce or aggravate oedema; (iii) maintenance fluid therapy aiming at isoosmolality will not worsen neurological outcome; and (iv) hypovolaemia is difficult to detect, and detrimental for cerebral perfusion, in these patients.

Thermal skin injury: Effect of fluid therapy on the transcapillary colloid osmotic gradient

The effects of fluid therapy on interstitial colloid osmotic and hydrostatic pressures in thermally injured skin were investigated in anesthetized rats subjected to full-thickness scald burns to 40% of the body surface area and resuscitation for 3 hr by either lactated Ringer's or plasma. Interstitial fluid hydrostatic pressure ( P if) was reduced from −2 mm Hg to −20 to −40 mm Hg after injury, which will profoundly increase transcapillary filtration. Following the onset of fluid therapy, P if increased to slightly positive values. In control, colloid osmotic pressure in plasma (COP p) was 20.6 ± 0.4 mm Hg and in interstitial fluid (COP if) 13.7 ± 0.3 mm Hg (means ± SEM). The transcapillary oncotic pressure gradient (COP grad = COP p − COP if) was 6.9 ± 0.4 mm Hg. Following nonresuscitated thermal injury, COP p declined to 18–19 mm Hg ( P < 0.05) and COP if was reduced to 10.4 ± 0.5 mm Hg ( P < 0.05). Fluid therapy by lactated Ringer's markedly reduced COP p (12.3 ± 0.3 mm Hg; P < 0.05), and COP grad was almost abolished (2.6 ± 0.7 mm Hg; P < 0.05). In contrast, plasma infusion maintained COP p, whereas COP grad increased significantly (11.1 ± 1.2 mm Hg; P < 0.05). Noncolloid saline solutions have been preferred for the initial fluid therapy for burns. The present study provides evidence that this will reduce both COP p and COP grad, a situation in which edema formation will be favored.

Effects of fluid therapy on serum glucose levels in fasted outpatients.

Effects of fluid therapy on serum glucose levels in fasted outpatients.

Pulmonary effects of fluid therapy

Pulmonary effects of fluid therapy

Effect of peritubular oncotic pressure changes on proximal tubular fluid reabsorption.

Effect of peritubular oncotic pressure changes on proximal tubular fluid reabsorption.

A Long-Term Study of Early Fluid Therapy in Severely Burned Adults

The effect of fluid therapy on shock mortality and late mortality has been studied in 308 severely burned adults. Two fluid regimens were compared simultaneously on an alternate-case basis. The results show (1) therapy with saline solutions alone was more effective than a fluid regimen deficient in electrolytes and (2) no additional advantage could be conclusively shown by combination of plasma with saline solutions. Furthermore, over a 14-year period there was only a 4% overall shock mortality in a total of 152 patients treated with saline solutions alone. There were no shock deaths in 127 patients with 10% to 50% surface-area burns. Late mortality, on the other hand, was not influenced by the early fluid therapy we employed.

Toxic Thromboplastic Extracts of Skin

IN 1962 IN THE US, 1.8 million patients were hospitalized with extensive burns and there were 11,500 deaths. 1 Despite advances in knowledge of the pathology of thermal burns, mortality remains high with many occurring after the initial shock. These late deaths are frequently ascribed to pulmonary involvement or infection. The initial treatment for shock is primarily replacement of body fluids accomplished by administration of large volumes of fluids, including solutions of sodium salts, colloidal solutions such as plasma, albumin, or dextran, and whole blood. It is noteworthy that in various hospitals in the US and in burn centers in Europe, widely differing combinations of these fluids are utilized. 2 In seeking improvements in therapy it is essential to reevaluate the experimental work to ascertain both the therapeutic potential and the limitations of fluid replacement. 1 Recently, S. M. Rosenthal compared the overall effect of fluid therapy in burn shock and

THE EFFECT OF FLUID ON THE TEMPERATURE AND BLOOD CONCENTRATION IN THE NEW-BORN WITH FEVER

In a previous paper 1 evidence was presented to show that a close relationship exists between fever in the new-born and dehydration. Whereas in afebrile new-born infants the protein concentration of blood serum is fairly constant, usually lying between 6 and 7 per cent., in the new-born with fever the serum proteins are generally above 7.5 per cent, and often over 9 per cent., indicating a marked diminution in the plasma water. In the experiments reported in this paper the effect of fluid therapy on the temperature and blood concentration of the new-born with fever was studied. Approximately 35 c.c. of fluid per kilogram of body weight (a total of from 100 to 150 c.c.), warmed above the temperature of the baby, were given and the temperature and blood concentration determined repeatedly before and after the fluid administration. The fluid was given in various ways—orally (gavage), hypodermically and intraperitoneally. The