Colloids vs. crystalloids--a continuing controversy.
The crystalloid vs. colloid controversy is based on a disagreement as to the most effective, safest, and most economical method of maintaining an effective plasma volume in shock patients. This review discusses Starling's law of fluid movement, with a definition of each term in the normal physiological state, and presents examples of how each component of Starling's law differs in the two major types of pulmonary edema: (1) cardiogenic and (2) noncardiogenic. The colloid-crystalloid literature is reviewed briefly with an emphasis on the major studies that support each side, and the deficiencies in each study. The arguments supporting each side of the crystalloid-colloid debate are then listed, with a summary that demonstrates the areas of agreement between the two schools of thought on fluid resuscitation. Each major colloid (albumin, dextran, hetastarch) and a representative crystalloid (lactated Ringer's) are discussed in terms of their chemistry; pharmacology and indications; and precautions, adverse reactions, and side effects. A table is included that summarizes the available products' data regarding composition, volume expansion, duration of expansion, half-life, metabolism, elimination, precautions, adverse reactions, and dose.
D001798:Blood Proteins / Q000378:metabolism; D001826:Body Fluids / Q000502:physiology; D002199:Capillary Permeability; D003102:Colloids; D000077324:Crystalloid Solutions; D003911:Dextrans / Q000009:adverse effects / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D006874:Hydrostatic Pressure; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000494:pharmacology; D007552:Isotonic Solutions / Q000009:adverse effects / Q000494:pharmacology; D009997:Osmotic Pressure; D010952:Plasma Substitutes / Q000627:therapeutic use*; D010953:Plasma Volume; D011654:Pulmonary Edema / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure; D000077325:Ringer's Lactate; D012709:Serum Albumin / Q000009:adverse effects / Q000627:therapeutic use; D012769:Shock / Q000628:therapy*
D001798:Blood Proteins; D003102:Colloids; D000077324:Crystalloid Solutions; D003911:Dextrans; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012709:Serum Albumin