Maintenance of Fluid Balance*

I N previous discussions of ffuid baIance1**g3 emphasis has aIways been pIaced upon individuahzing the treatment to fit the needs of the patient, and further experience has more firmIy estabIished the soundness of this view. If a patient can take Auids by mouth there is generaIIy no problem concerning the maintenanceof a good fluid baiance, and muchof the materia1 in thisarticIe has no bearing on such cases. UnfortunateIy often in emergency situations, for one reason or another, the patient cannot take fluids by mouth and the proper parentera therapy is in the hands of the physician. Emergency surgery commonIy invoIves patients who are we11 up to the time of an acute trauma, and there are often no Iong standing deficiencies to dea1 with. In traumatic injuries, shock is of rather common occurrence and its prevention and treatment have been we11 discussed in the preceding articIe by Cressman and BIaIock,4 who, among other things, point out the dangers of administering Iarge amounts of gIucose or saIine solutions when shock is present. This wiI1 be referred to later, but it here serves we11 to point out that the administration of fluids in emergency situations requires thought based on facts if one is to seIect the proper kind and amount of ffuid to give. Considering the kind of fluid to use, the choice is between the saIine and gIucose soIutions, and the important point is that there is possibIe harm with the use of the saIine and practicaIIy none with the gIucase. The reIation of sodium chIoride to edema is common knowIedge and yet several Iiters of physioIogic saIine or Ringer’s solution may be given daiIy to patients who can iI afford the edema of saIt on top of the edema of trauma. AccordingIy, a few references to this possibIe harmfu1 effect of saIine soIutions are in order.