Fluids are drugs: type, dose and toxicity.

Published

Journal Article (Review)

PURPOSE OF REVIEW: We discuss the formulation of a prescription for intravenous (i.v.) fluid therapy (a 'volume prescription') for critically ill patients: pros/cons of different fluid types; accurate dosing; and qualitative and quantitative toxicities. Updated physiologic concepts are invoked and results of recent major clinical trials on i.v. fluid therapy in the acutely ill are interpreted. RECENT FINDINGS: Context is vital and any fluid can be harmful if dosed incorrectly. When contrasting 'crystalloid versus colloid', differences in efficacy are modest, but differences in safety are significant. Differences in chloride load and strong ion difference appear to be clinically important. Quantitative toxicity is mitigated when dosing is based on dynamic parameters that predict volume responsiveness. Qualitative toxicity for colloids (even with newer hydroxyethyl starch 130/0.4 solutions) and isotonic saline remain a concern. SUMMARY: Similar to any drug used in acutely ill patients, clinicians ordering a volume prescription must recognize that context is crucial. Physiologically balanced crystalloids may be the 'default' fluid for acutely ill patients, and the role for colloids is unclear. Optimal dosing involves assessment of volume responsiveness.

Full Text

Duke Authors

Cited Authors

  • Raghunathan, K; Shaw, AD; Bagshaw, SM

Published Date

  • August 2013

Published In

Volume / Issue

  • 19 / 4

Start / End Page

  • 290 - 298

PubMed ID

  • 23817025

Pubmed Central ID

  • 23817025

Electronic International Standard Serial Number (EISSN)

  • 1531-7072

Digital Object Identifier (DOI)

  • 10.1097/MCC.0b013e3283632d77

Language

  • eng

Conference Location

  • United States