Fluids, pH, ions and electrolytes.
OBJECTIVE
Significant attention has been recently focused on both maintenance fluid and resuscitation fluid use in critical care. Accordingly, a focused review of the properties of crystalloid and colloid fluids, their expected benefits, and potential deleterious side effects is appropriate and timely.


RESULTS
Despite their ubiquitous use, well described side effects, and ability to be titrated to a physiologic endpoint, fluids are rarely considered in a fashion similar to other pharmacologic agents. Understanding their physical and chemical properties allows the clinician to understand, anticipate and deliberately harness their expected impact on acid-base balance. Expanded insights into the pathogenesis of common acid-base disorders may be gleaned from utilizing a physicochemical approach that allows the precise quantification of the ionic species that impact pH.


CONCLUSIONS
This focused review further enables the clinician to appropriately investigate, modify, and optimize bedside clinical care related to fluid and acid-base management.
Kaplan
Lewis J
LJ
Yale University School of Medicine, Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, New Haven, Connecticut, USA.
Kellum
John A
JA
D000138:Acidosis; D000418:Albumins; D000687:Amylopectin; D055598:Chemical Phenomena; D002712:Chlorides; D003102:Colloids; D000077324:Crystalloid Solutions; D003911:Dextrans / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use; D004573:Electrolytes / Q000737:chemistry*; D005440:Fluid Therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006955:Hypernatremia / Q000517:prevention & control; D007008:Hypokalemia / Q000517:prevention & control; D007010:Hyponatremia / Q000517:prevention & control; D007552:Isotonic Solutions / Q000627:therapeutic use*; D009994:Osmolar Concentration; D011188:Potassium; D012151:Resuscitation; D012964:Sodium
D000418:Albumins; D002712:Chlorides; D003102:Colloids; D000077324:Crystalloid Solutions; D003911:Dextrans; D004573:Electrolytes; D007552:Isotonic Solutions; D000687:Amylopectin; D012964:Sodium; D011188:Potassium