RT Book, Section
A1 Neal, Matthew D.
A2 Brunicardi, F. Charles
A2 Andersen, Dana K.
A2 Billiar, Timothy R.
A2 Dunn, David L.
A2 Kao, Lillian S.
A2 Hunter, John G.
A2 Matthews, Jeffrey B.
A2 Pollock, Raphael E.
SR Print(0)
ID 1175968573
T1 Fluid and Electrolyte Management of the Surgical Patient
T2 Schwartz's Principles of Surgery, 11e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259835353
LK accesssurgery.mhmedical.com/content.aspx?aid=1175968573
RD 2024/04/19
AB Key  PointsProper  management  of  fluid  and  electrolytes  facilitates  crucial  homeostasis  that  allows  cardiovascular  perfusion,  organ  system  function,  and  cellular  mechanisms  to  respond  to  surgical  illness.Knowledge  of  the  compartmentalization  of  body  fluids  forms  the  basis  for  understanding  pathologic  shifts  in  these  fluid  spaces  in  disease  states.  Although  difficult  to  quantify,  a  deficiency  in  the  functional  extracellular  fluid  compartment  often  requires  resuscitation  with  isotonic  fluids  in  surgical  and  trauma  patients.Alterations  in  the  concentration  of  serum  sodium  have  profound  effects  on  cellular  function  due  to  water  shifts  between  the  intracellular  and  extracellular  spaces.Different  rates  of  compensation  between  respiratory  and  metabolic  components  of  acid-base  homeostasis  require  frequent  laboratory  reassessment  during  therapy.Although  active  investigation  continues,  alternative  resuscitation  fluids  have  limited  clinical  utility,  other  than  the  correction  of  specific  electrolyte  abnormalities.Enhanced  recovery  after  surgery  (ERAS)  protocols  have  markedly  changed  perioperative  fluid  management  and  are  being  used  more  frequently.  ERAS  minimizes  perioperative  fluid  administration  and  focuses  on  early  enteral  intake  to  reduce  morbidity  associated  with  IV  fluid  administration.Most  acute  surgical  illnesses  are  accompanied  by  some  degree  of  volume  loss  or  redistribution.  Consequently,  isotonic  fluid  administration  is  the  most  common  initial  intravenous  fluid  strategy,  while  attention  is  being  given  to  alterations  in  concentration  and  composition.Some  surgical  patients  with  neurologic  illness,  malnutrition,  acute  renal  failure,  or  cancer  require  special  attention  to  well-defined,  disease-specific  abnormalities  in  fluid  and  electrolyte  status.