Intravenous solutions in the care of patients with volume depletion and electrolyte abnormalities.
Infusion fluids are often given to restore blood pressure (volume resuscitation), but may also be administered to replace ongoing losses, match insensible losses, correct electrolyte or acid-base disorders, or provide glucose. The development of new infusion fluids has provided clinicians with a wide range of products. Although the choice for a certain infusion fluid is often driven more by habit than by careful consideration, we believe it is useful to approach infusion fluids as drugs and consider their pharmacokinetic and pharmacodynamic characteristics. This approach not only explains why infusion fluids may cause electrolyte and acid-base disturbances, but also why they may compromise kidney function or coagulation. In this teaching case, we present a 19-year-old patient in whom severe hypernatremia developed as a result of normal saline solution infusion and explore the pharmacokinetic and pharmacodynamic effects of frequently used infusion fluids. We review clinical evidence to guide the selection of the optimal infusion fluid.
Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: d.severs@erasmusmc.nl.
David
D
Severs
Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
Maarten B
MB
Rookmaaker
Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, the Netherlands.
Ewout J
EJ
Hoorn
D000138:Acidosis / Q000209:etiology; D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications; D001810:Blood Volume; D002547:Cerebral Palsy / Q000150:complications; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D003102:Colloids / Q000009:adverse effects / Q000627:therapeutic use; D003422:Critical Care; D000077324:Crystalloid Solutions; D004827:Epilepsy / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D005440:Fluid Therapy; D016908:Gram-Positive Bacterial Infections / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D006955:Hypernatremia / Q000139:chemically induced* / Q000628:therapy; D008607:Intellectual Disability / Q000150:complications; D007552:Isotonic Solutions / Q000009:adverse effects / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use; D007668:Kidney / Q000503:physiopathology*; D010952:Plasma Substitutes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced; D016459:Prosthesis-Related Infections / Q000209:etiology; D012151:Resuscitation / Q000379:methods; D012965:Sodium Chloride / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced*; D055815:Young Adult
D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012965:Sodium Chloride
Chloride; acute kidney injury (AKI); crystalloids; hypernatremia; hyponatremia; infusion fluid; intravenous solution; normal saline; solute diuresis; volume resuscitation