Dehydration and fluid volume kinetics before major open abdominal surgery

Hahn, Robert G.; Bahlmann, Hans; Nilsson, Lena

doi:10.1111/aas.12416

Cited by 34 publications

(49 citation statements)

References 19 publications

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“…Two previous studies of elderly hospital patients showed that fluid retention worsens outcome [19,20]. Pre-operative patients with concentrated urine eliminate Ringer's acetate more slowly [21], which supports the present findings.…”

Section: Discussionsupporting

confidence: 91%

Isotonic saline in elderly men: an open‐labelled controlled infusion study of electrolyte balance, urine flow and kidney function

et al. 2015

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SummaryIsotonic saline is a widely-used infusion fluid, although the associated chloride load may cause metabolic acidosis and impair kidney function in young, healthy volunteers. We wished to examine whether these effects also occurred in the elderly, and conducted a crossover study in 13 men with a mean age of 73 years (range 66-84), who each received intravenous infusions of 1.5 l of Ringer's acetate and of isotonic saline. Isotonic saline induced mild changes in plasma sodium (mean +1.5 mmol.l À1 ), plasma chloride (+3 mmol.l À1 ) and standard bicarbonate (À2 mmol.l À1 ). Three hours after starting the infusions, 68% of the Ringer's acetate and 30% of the infused saline had been excreted (p < 0.01). The glomerular filtration rate increased in response to both fluids, but more after the Ringer's acetate (p < 0.03). Pre-infusion fluid retention, as evidenced by high urinary osmolality (> 700 mOsmol.kg À1 ) and/or creatinine (> 7 mmol.l À1 ), was a strong factor governing the responses to both fluid loads.

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Section: Discussionsupporting

confidence: 91%

Isotonic saline in elderly men: an open‐labelled controlled infusion study of electrolyte balance, urine flow and kidney function

et al. 2015

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“…At baseline, the FRI of one third reached 4.0, which implicates dehydration [4]. In a previous study, FRI was 2.8 before open abdominal surgery when the patients took oral fluid on demand up to two hours preoperatively [5]. A FRI of 2.8 was also found in our subgroup that was given 500 ml of Ringer´s lactate several hours prior to surgery.…”

Section: Discussionsupporting

confidence: 66%

“…However, accumulating evidence suggests that concentrated urine is of importance to health in hospital patients. Concentrated urine strongly affects how patients humans handle intravenous fluid [5,6] and is associated with a higher incidence of postoperative complications after hip fracture surgery [1] and higher mortality in acute geriatric care [7].…”

Section: Introductionmentioning

confidence: 99%

Fluid Retention is Alleviated by Crystalloid but Not by Colloid Fluid after Induction of General Anesthesia: An Open-Labeled Clinical Trial

Hahn¹,

Li²

2016

J Anesth Clin Res

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“…Renal water conservation in the form of a high fluid retention index (FRI) was common, despite taking precautions like minimum-delay surgery and preoperative fluid administration. Our patients had an average FRI of 4.0, which can be compared to 2.8 in patients awaiting elective abdominal surgery [8] and 2.7 in healthy volunteers just before and 3.55 after a 90-min recreational physical exercise [7]. The FRI did not decrease during the surgical procedure, although fluid administration was not restrictive (mean 2.2 L during the surgery).…”

Section: Discussionmentioning

confidence: 68%

“…The colours used have been assigned RGB codes [7]. One urine tube was used to measure albumin excretion (a sign of glomerular damage), as well as the concentration of metabolic waste products (which can be used to quantify the degree of dehydration-induced renal water conservation) [7,8].…”

Section: Methodsmentioning

confidence: 99%

Renal injury during hip fracture surgery: an exploratory study

Hahn

2015

Anaesthesiol Intensive Ther

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Background: The present observational study was undertaken to identify potential markers of poor outcome, such as renal failure and mortality, after hip fracture surgery. Methods: Forty-three patients, with a mean age of 78 years, were studied having undergone acute hip fracture surgery. Analysis included the urinary excretion of cortisol, albumin and sodium. The degree of fluid retention was evaluated based on the urinary excretion of metabolic end products. Fluid retention and the excretion of albumin and neutrophil gelatinase-associated lipocalin (NGAL) were measured repeatedly in a sub-group of 15 patients who also underwent haemodynamic monitoring. The perioperative change in serum creatinine and a 30-day mortality served as outcome measures. Results: Although serum creatinine increased by > 25% in 21% of the patients, only a high preoperative creatinine concentration correlated with a 30-day mortality. The subgroup analysis revealed that fluid retention was pronounced and remained essentially unchanged up to the first postoperative day. A rise in serum creatinine was always preceded by increased urinary excretion of NGAL that, in turn, was associated with preoperative fluid retention. The only perioperative event that correlated with a higher 30-day mortality was perioperative aggravation of albuminuria (67% vs 0%, P < 0.01), which became more common with advanced age and a low cardiac index. Conclusions: Two different mechanisms seem to affect the kidneys during hip fracture surgery. The first elevates the serum creatinine concentration while the second increases the albuminuria. Only the second mechanism had a bearing on mortality.

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Dehydration and fluid volume kinetics before major open abdominal surgery

Abstract: The degree of dehydration before major surgery was modest as evidenced both by urine sampling and volume kinetic analysis.

Cited by 34 publications

References 19 publications

Isotonic saline in elderly men: an open‐labelled controlled infusion study of electrolyte balance, urine flow and kidney function

Isotonic saline in elderly men: an open‐labelled controlled infusion study of electrolyte balance, urine flow and kidney function

Fluid Retention is Alleviated by Crystalloid but Not by Colloid Fluid after Induction of General Anesthesia: An Open-Labeled Clinical Trial

Renal injury during hip fracture surgery: an exploratory study

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