Detection of Dehydration by Using Volume Kinetics

Zdolsek, Joachim; Li, Yuhong; Hahn, Robert G.

doi:10.1213/ane.0b013e318261f6ba

Cited by 34 publications

(32 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The elimination T 1/2 of Ringer´s acetate was recently reported to average 21 minutes in well-hydrated, conscious volunteers, and 82 minutes in the presence of mild volume depletion [16]. The T 1/2 of 88 minutes in the present single-infusion experiment suggests the mild volume depletion was present after the overnight fast despite ingestion of one glass of liquid 2 hours before the experiments started.…”

Section: Discussionsupporting

confidence: 49%

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

et al. 2013

Self Cite

View full text Add to dashboard Cite

IntroductionThe turnover of Ringer´s solutions is greatly dependent on the physiological situation, such as the presence of dehydration or anaesthesia. The present study evaluates whether the kinetics is affected by previous infusion of colloid fluid.MethodsTen male volunteers with a mean age of 22 years underwent three infusion experiments, on separate days and in random order. The experiments included 10 mL/kg of 6% hydroxyethyl starch 130/0.4 (Voluven™), 20 mL/kg of Ringer's acetate, and a combination of both, where Ringer´s was administered 75 minutes after the starch infusion ended. The kinetics of the volume expansion was analysed by non-linear least- squares regression, based on urinary excretion and serial measurement of blood haemoglobin concentration for up to 420 minutes.ResultsThe mean volume of distribution of the starch was 3.12 L which agreed well with the plasma volume (3.14 L) estimated by anthropometry. The volume expansion following the infusion of starch showed monoexponential elimination kinetics with a half-life of two hours. Two interaction effects were found when Ringer´s acetate was infused after the starch. First, there was a higher tendency for Ringer´s acetate to distribute to a peripheral compartment at the expense of the plasma volume expansion. The translocated amount of Ringer´s was 70% higher when HES had been infused earlier. Second, the elimination half-life of Ringer´s acetate was five times longer when administered after the starch (88 versus 497 minutes, P <0.02).ConclusionsStarch promoted peripheral accumulation of the later infused Ringer´s acetate solution and markedly prolonged the elimination half-life.Trial registrationClinicalTrials.gov: NCT01195025

show abstract

Section: Discussionsupporting

confidence: 49%

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…Less prominent plasma dilution following infusion of fluid has been considered to represent reduced dehydration (2,9). Other research has demonstrated that larger and more sustained volume expansion in animals or humans is obtained under conditions of hypovolemia (10,11), which is consistent with the results of the present study. Low blood volume due to various reasons, such as anesthesia (12), increases anti-diuretic hormone (ADH) and aldosterone, resulting in reduction of renal blood flow.…”

Section: Discussionsupporting

confidence: 91%

Comparison of the hemodynamics and dynamics of fluid shift of Ringer's solution before surgery in children and adults

Zhu

et al. 2017

Experimental and Therapeutic Medicine

Self Cite

View full text Add to dashboard Cite

Abstract. The present study investigated the hemodynamics, vascular and extravascular volume expansion induced by infusion of lactated Ringer's solution in children and adults before surgery. This was a prospective randomized double-blind study. A total of 28 patients (14 children and 14 adult patients; American Society of Anesthesiology status I) scheduled for similar minor pelvic, anal rectal or lower limb surgery were recruited for the present study. All patients were administered with 10 ml/kg of lactated Ringer's solution at a constant rate over 20 min. After fluid infusion, plasma dilutions were calculated based on the concentration of hemoglobin. Heart rate (HR), mean arterial pressure (MAP) and urine output were measured before anesthesia was administered for surgery. Results demonstrated that the plasma dilution within 90 min of infusion initiation of lactated Ringer's solution was less pronounced in children compared with adult patients (0.07 vs. 0.16; P<0.001). Children also excreted more of the infused fluid through the kidney within 90 min of infusion initiation than the adults (55% vs. 24%; P=0.01). Following completion of fluid infusion, the volume expansion efficiency was higher in adults [0.82 (0.52-1.00)] than in children [0.46 (0.26-0.68)]. The relative changes in HR were significantly greater in children than in adults 15-60 min after infusion initiation (P<0.01). After 60 min, HRs were comparable between the groups; however, MAP declined significantly from 25-90 min after infusion initiation in children (P<0.05), yet remained nearly constant in adults (P>0.05). Simple regression analysis revealed a positive relationship between the relative changes in MAP and the plasma dilution, and the reduction in MAP in children was able to explain 47% of the variation in plasma dilution (R 2 =0.47; P=0.007). In conclusion, different hemodynamics and dynamics of fluid shift of Ringer's solution prior to surgery in children and adults may provide anesthesiologists with new information of how to administer fluid treatment for each patient.

show abstract

“…This largely explains some of the seeming discrepancies noted above and, conversely, implies that the hemodynamic effects of crystalloids are much less than of roughly equal amounts of infused colloids. Otherwise, the greater the hypovolemia, the slower the clearance and longer the half life are of a given infused crystalloid fluid volume, as calculated from kinetics of hemoglobin concentrations [29]. Finally, accommodation by unstressed volume in compliant veins attenuates the plasma volume expanding effect of infusion fluids.…”

Section: Reviewmentioning

confidence: 99%

Dose and type of crystalloid fluid therapy in adult hospitalized patients

2013

View full text Add to dashboard Cite

ObjectiveIn this narrative review, an overview is given of the pros and cons of various crystalloid fluids used for infusion during initial resuscitation or maintenance phases in adult hospitalized patients. Special emphasis is given on dose, composition of fluids, presence of buffers (in balanced solutions) and electrolytes, according to recent literature. We also review the use of hypertonic solutions.MethodsWe extracted relevant clinical literature in English specifically examining patient-oriented outcomes related to fluid volume and type.ResultsA restrictive fluid therapy prevents complications seen with liberal, large-volume therapy, even though restrictive fluid loading with crystalloids may not demonstrate large hemodynamic effects in surgical or septic patients. Hypertonic solutions may serve the purpose of small volume resuscitation but carry the disadvantage of hypernatremia. Hypotonic solutions are contraindicated in (impending) cerebral edema, whereas hypertonic solutions are probably more helpful in ameliorating than in preventing this condition and improving outcome. Balanced solutions offer a better approach for plasma composition than unbalanced ones, and the evidence for benefits in patient morbidity and mortality is increasing, particularly by helping to prevent acute kidney injury.ConclusionsIsotonic and hypertonic crystalloid fluids are the fluids of choice for resuscitation from hypovolemia and shock. The evidence that balanced solutions are superior to unbalanced ones is increasing. Hypertonic saline is effective in mannitol-refractory intracranial hypertension, whereas hypotonic solutions are contraindicated in this condition.

show abstract

Detection of Dehydration by Using Volume Kinetics

Cited by 34 publications

References 24 publications

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

Comparison of the hemodynamics and dynamics of fluid shift of Ringer's solution before surgery in children and adults

Dose and type of crystalloid fluid therapy in adult hospitalized patients

Contact Info

Product

Resources

About