Fluid replacement
Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced with oral rehydration therapy (drinking), intravenous therapy, rectally such as with a Murphy drip, or by hypodermoclysis, the direct injection of fluid into the subcutaneous tissue. Fluids administered by the oral and hypodermic routes are absorbed more slowly than those given intravenously.
Fluid replacement
Fluid resuscitation
Clinical uses[edit]
Septic shock[edit]
Fluid replacement in patients with septic shock can be divided into four stages as shown below:
Fluid overload[edit]
Fluid overload is defined as an increase in body weight of over 10%.[11] Aggressive fluid resuscitation can lead to fluid overload which can lead to damage of multiple organs: cerebral oedema, which leads to delirium; pulmonary oedema and pleural effusion, which lead to respiratory distress; myocardial oedema and pericardial effusion, which lead to impaired contractility of the heart; gastrointestinal oedema, which leads to malabsorption; hepatic congestion, which leads to cholestasis and acute kidney injury; and tissue oedema, which leads to poor wound healing. All these effects can cause disability and death, and increase in hospitalisation costs.[10]
Fluid overload causes cardiac dilation, which leads to increased ventricular wall stress, mitral insufficiency and leads to cardiac dysfunction. Pulmonary hypertension can lead to tricuspid insufficiency. Excess administration of fluid causes accumulation of extracellular fluid, leading to pulmonary oedema and lack of oxygen delivery to tissues. The use of mechanical ventilation in such case can cause barotrauma, infection, and oxygen toxicity, leading to acute respiratory distress syndrome.[11] Fluid overload also stretches the arterial endothelium, which causes damage to the glycocalyx, leading to capillary leakage and worsens the acute kidney injury.[15]
Other treatments[edit]
Proctoclysis, an enema, is the administration of fluid into the rectum as a hydration therapy. It is sometimes used for very ill persons with cancer.[16] The Murphy drip is a device by means of which this treatment may be performed.