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Fluid resuscitation (Hypovolemia (types (Absolute hypovolemia - body fluid…

- - - - rapidly enters the intracellular compartment
        
        leads to increase of CO2, lactate and finally increases ischaemic brain injury
        
        not useful in correction of hypovolemia
      - Indications
        
        Risk of hypoglycaemia
        
        When water loss > electrolytes loss
    - - similar to plasma
        
        osmolarity < plasma osmolarity – not isotonic
        
        has the physiological electrolyte pattern of plasma
        
        has the metabolizable anion (lactate) to replace HCO3 tissue --> acidosis can be prevented
    - - Na and Cl concentration exceeds that of plasma
        
        there are no K, Ca, Mg, glucose
        
        there is no bicarbonate or metabolizable anions
        
        Acid base disorders – metabolic acidosis (hyperchloremic acidosis)
      - Hyperchloremic acidosis
        
        Consequences
        ↓ renal blood flow ( vasoconstriction) and GFR
        ↑ induced NO synthesis
        impaired cells function
        ↓ splanchnic blood flow in elderly
        coaguation impairment – risk of bleeding
        slowing of gastric emptying
        ↓ contractility of cardiac muscle and haemodynamic stability
  - - - Artificial colloids
        dextrans
        hydroxyethyl starch (HES)
        gelatins
        
        Dextrans
        macromolecular polimers of glucose, produced by Leuconostoc mesenteroides
        excreted by kidneys or to glucose, CO2 and H2O
        
        Dextran 40
        Important rheology changes
        ↓ blood viscosity
        Prevents erythrocytes aggregation
        Prevents adhesing of leucocytes to damaged endothelium
        
        AKI
        Hyperoncotic, Occlusion of tubules, Direct toxic effect
        
        Gelatins
        gelatin is denatured collagen, typically isolated from bovine or porcine skin or bone by acid or base extraction
        effect of volume lasts only for 30 min
        T 1⁄2 in plasma is 1-2 hours
        
        advantages
        do not cumulate in the body
        do not disturb function of kidney
        are not associated with impairment of coagulation or cross matching
        often allergic reactions - 0,34% ~ dextrans
        
        Hydroxyethyl starch (HES)
        HES is/was the most commonly used artificial colloid worldwide
        is a modified branched polymer of the natural amylopectin
        composed of molecules derived from corn starch or potatoe modified by hydroxyethylation
        HES is hydrolyzed by serum amylase
        rapidly lost by renal elimination
        
        Characteristics of HES
        minimal influence on hemostasis
        blood rheology improvement
        cumulation in tissue – itching
        Voluven doesn’t cross impaired b-b barier
        Inhibition of inflammatory processes
        Activation of endothelium
        Decreasing leakage of endothelium
        
        disadvantages
        Risk of hiperoncotic
        AKI
        Voluven < than high molecular
        High molecular - bleeding
        Voluven – safe
        Itching – not with Voluven
        increase serum α-amylase - few days
      - Natural colloids
        albumin
        
        1/3 intravascular , 2/3 extravascular
        1/2 of amount is located under the skin (loss in case of burns)
        70 -80% responsability for COP
        ↓ toxicity of many toxic substances (binding)
        Free oxygen radicals removers
- - - - interstitial fluid volume 15%
      - intravascular fluid volume 5%