title: Isotonic and hypertonic crystalloid solutions in the critically ill.
abstract: Disorders of fluid and electrolyte balance in the critically ill are volume-related, compositional, or both. Targeting 'normal' values for plasma volume, osmolality and electrolytes might not be optimal in conditions as diverse as intracranial trauma/haemorrhage, hepatic encephalopathy, abdominal hypertension, or major surgery, because a hyperosmolar state seems to favourably affect tissue (brain and intestinal) oedema formation. However, adequately powered studies regarding the impact of hypertonic saline on outcome are lacking. Isotonic crystalloids are the cornerstone of resuscitation and must be balanced against natural or artificial colloids and vasopressors. Crystalloid resuscitation is superior to vasopressors in shock associated with blunt trauma, and is at least not inferior to colloids in septic shock. Traditional rules of thumb indicating the need for three to four times the amount of crystalloids for the plasma volume to be replaced are probably erroneous and might have contributed to association of overly aggressive crystalloid resuscitation with poor outcome.
authors: Department of Anesthesiology and Intensive Care Therapy, Friedrich-Schiller-University, Erlanger Allee, 101, D-07747 Jena, Germany. michael.bauer@med.uni-jena.de
authors: Michael
authors: M
authors: Bauer
authors: Andreas
authors: A
authors: Kortgen
authors: Christiane
authors: C
authors: Hartog
authors: Niels
authors: N
authors: Riedemann
authors: Konrad
authors: K
authors: Reinhart
mesh_terms: D003102:Colloids; D016638:Critical Illness; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D006982:Hypertonic Solutions; D007552:Isotonic Solutions / Q000008:administration & dosage*; D012151:Resuscitation / Q000379:methods*
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D006982:Hypertonic Solutions; D007552:Isotonic Solutions