Acid-Base, Electrolyte and Fluid Alterations: Review

Background: Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients. Apart from the amount of fluid utilized for resuscitation, the type of fluid used also impacts patient outcome. Colloids and crystalloids are two types of fluids that are utilized for resuscitation. The efficacy of each fluid type on the expansion of intravascular volume on one hand and the potential adverse effects of each individual fluid, on the other hand, need to be considered when choosing the type of fluid for resuscitation. The negative impact of hydroxyethyl starch on kidney function, of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function, are only examples of new develReceived: January 27, 2016 Accepted: April 19, 2016 Published online: May 18, 2016 Kianoush Kashani, MD Division of Nephrology and Hypertension Department of Medicine, Mayo Clinic 200 First Street SW, Rochester, MN 55905 (USA) E-Mail kashani.kianoush @ mayo.edu © 2016 S. Karger AG, Basel 2296–9381/16/0022–0064$39.50/0 www.karger.com/kdd Contribution from the 1st Conference of the International Network of Diagnosis and Management of Acid-Base, Electrolyte, and Fluid Alterations ‘Diagnosis and Management of Acid-Base, Electrolyte and Fluid Alterations in Critically-Ill Patients’ held in Shanghai and Hangzhou on January 14–16, 2016. D ow nl oa de d by : 54 .1 91 .4 0. 80 9 /1 7/ 20 17 9 :2 5: 03 A M