Unappreciated aspects of fluid and electrolyte physiology and implications to patient recovery

Excerpt

Fluid and electrolyte management of the critically ill patient is a “core skill” for the anesthesiologist and intensivist. Critically ill patients often present with any of a number of insults that result in fluid and electrolyte derangements, and an important part of resuscitative therapy is aggressive fluid and electrolyte management. Once the initiating insult has been stabilized, electrolyte and fluid management often continues to occupy a central component of therapy, and is usually directed at trying to re-establish physiologically appropriate interstitial and vascular compartment volumes. Despite 30 years of research, basic questions are still debated concerning the type of fluid to administer (blood products, artificial colloids, or crystalloids), the amount of fluid to administer (the choice and measurement of appropriate physiological indices), and the clinical scenario wherein fluids should be administered (acute trauma, head injury, sepsis, major surgery, or heart- renal- or hepatic failure, etc.).1 Indeed, the challenge of fluid and electrolyte management in the critically ill patient is somewhat analogous to the question of whether a regional or general anesthetic is best for hip replacement in a frail 92-yr-old woman with poor heart function and tenuous kidneys. While there are many components to the question, the answer is often reduced to “a good anesthetic is better than a bad one”. By extension, proper fluid and electrolyte management is better than inappropriate management. While the answer may be unsatisfying to residents, they can be re-assured that the answer(s) becomes clearer after they gain a thorough understanding of the physiology of fluid and electrolytes and once they acquire several years of experience. …