Nutrition and fluid therapy
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Fluid therapy and nutritional support are fundamental to good surgical practice. Accurate fluid administration demands an understanding of maintenance requirements and an appreciation of the consequences of surgical disease on fluid losses. This requires knowledge of the consequences of surgical intervention and, in particular, intestinal resection. Malnutrition is common in hospital patients. All patients who have sustained or who are likely to sustain 5 days of inadequate oral intake should be considered for nutritional support. This may be dietetic advice alone, sip feeding or enteral or parenteral nutrition. These are not mutually exclusive. The success or otherwise of nutritional support should be determined by tolerance to nutrients provided and nutritional end points, such as weight. It is unrealistic to expect nutritional support to alter the natural history of disease. It is imperative that nutrition-related morbidity is kept to a minimum. This necessitates the appropriate selection of feeding method, careful assessment of fluid, energy and protein requirements, which are regularly monitored, and the avoidance of overfeeding.
Electrolyte and Acid-Base Disturbances
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
The goal of fluid therapy for dehydration is to restore euvolemia without inducing or worsening electrolyte disorders. The treatment includes controlling precipitating factors, replacing the fluid deficit, and providing sufficient maintenance fluid to prevent a recurrence of dehydration. Depending upon the primary cause, pharmacotherapy with antidiarrheal agents, antisecretory drugs, or antiemetics may be indicated. Fluid deficit generally can be replenished using oral rehydration therapy; however, IV fluid is preferred in patients with significant cardiovascular signs/symptoms (e.g., severe hypotension), altered mental status, inability to tolerate oral/enteral fluid due to refractory nausea and vomiting, or uncontrolled diarrhea. Importantly, oral rehydration therapy is more effective in preventing and delaying dehydration rather than treating dehydration associated with severe diarrhea [16].
Complications of Acute Fluid Loss and Replacement
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The use of intravenous fluids is one of the main pillars of resuscitative therapy for surgical patients. Many conditions, such as acute hemorrhage, burn injuries, and intra-abdominal inflammatory catastrophes, require appropriate fluid resuscitation. The clinician must be very familiar with the type and proper dosage of the many available solutions. Clear objectives and end points of resuscitation strategies must be determined in advance, and the possible side effects and complications need to be predicted and identified early in the course of treatment if the best possible outcome is to be achieved. Unfortunately, fluid therapy is not always seen as a pharmacologic intervention, but we must realize that fluids, like any other drug, may be indicated or contra-indicated in specific situations.
Hyperosmolar hyperglycemic syndrome in a young boy
Published in Baylor University Medical Center Proceedings, 2019
Archana Reddy, Leland Finley, Shawn Horrall
Unfortunately, there are no prospective data to guide management of HHS in a pediatric patient. It is recommended that pediatric patients with HHS be admitted to the intensive care unit. The goal of fluid therapy is to increase intravascular volume.8 During initial volume repletion, declining serum osmolality may lead to fluid shifts from intravascular to extravascular spaces, and ongoing urinary loss may persist for hours; therefore, ongoing fluid replacement is recommended. A fluid deficit of 12% to 15% of body weight can be assumed in pediatric patients, and a 20 mL/kg normal saline bolus is recommended. Subsequently, 0.45% or 0.75% sodium should be administered over 24 to 48 hours.8–13 Use of hypotonic fluid is preferred, because adult studies suggest that use of isotonic solutions during osmotic diuresis may increase serum sodium concentration, because the urine sodium concentration is hypotonic in comparison to serum.14 Early insulin treatment in HHS is unnecessary and may increase mortality. A rapid decline in glucose concentration with the use of insulin may lead to cerebral edema as well as circulatory compromise. If glucose levels are declining <50 mg/dL/h, insulin therapy may be considered.5 When insulin treatment is begun, continuous administration at 0.025 to 0.05 units/kg/h can be used initially. Boluses are not recommended in the pediatric population. Electrolyte imbalances may be more profound in HHS than in diabetic ketoacidosis, so potassium levels should be checked and replenished immediately.9
Goal-directed fluid therapy compared to liberal fluid therapy in patients subjected to colorectal surgery
Published in Egyptian Journal of Anaesthesia, 2023
Mona Gad Mostafa Elebieby, Mohamed Abdelkhalek, Zenat Eldadamony Mohamed Eldadamony, Mohammed Nashaat Mohammed
Between the studied groups, there were no appreciable differences in the patients’ demographics, type of surgery, or procedure length (Table 1). Also, the studied groups’ intraoperative and postoperative measurements for H.R., MAP, CVP, and S.V. were comparable (Table 2). Readings taken intraoperatively for SVV, COP, CI, and TFC were also comparable (Table 3). The serum lactate and creatinine levels of the GDFT group were slightly elevated compared to those of the LFT group, although this difference did not reach statistical significance (Figures 2, 3). Concerning the administration of fluids during surgery, it was observed that patients with liberal fluid therapy (LFT) required significantly higher amounts of crystalloid fluids, with a median volume of 2915 mL (range: 1736–4189 mL), compared to patients undergoing goal-directed fluid therapy (GDFT), who had a median volume of 2272 mL (range: 1352–2964 mL). This difference was found to be significant (P < 0.001).
Identification of risk factors associated with postoperative acute kidney injury after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a retrospective study
Published in International Journal of Hyperthermia, 2018
Juan P. Cata, Acsa M. Zavala, Antoinette Van Meter, Uduak U. Williams, Jose Soliz, Mike Hernandez, Pascal Owusu-Agyemang
Preoperative oral tramadol (300 mg), celecoxib (400 mg) or pregabalin (75 mg) was typically administered within two hours of anaesthesia induction according to anaesthesiologist clinical judgement. All patients had general anaesthesia using a combination of opioids, volatile anaesthetic (i.e. desflurane) in oxygen or total intravenous anaesthesia (propofol) and muscle relaxation with a non-depolarising or a depolarising muscle relaxant. Intraoperative fluid therapy consisted of a combination of crystalloids (Plasmalyte®, Baxter International, Deerfield, IL) and colloids (6% hetastarch, Hextend®, BioTime, Inc., Berkeley, CA; or albumin 5%, Buminate®, Baxter, San Juan, Puerto Rico) that was administered according to the attending anaesthesiologist’s clinical judgement. Ureteral stents were placed before surgical incision at discretion of primary surgery. Intraperitoneal chemotherapy was administered according to tumour type and surgeon’s choice. Perioperative blood product transfusions were given to maintain a haemoglobin (Hb) concentration between 8 and 10 g/dL. Postoperative analgesia consisted of either patient-controlled epidural analgesia and/or intravenous patient-controlled analgesia.
Related Knowledge Centers
- Blood Transfusion
- Circulatory System
- Route of Administration
- Oral Administration
- Medication
- Electrolyte
- Electrolyte Imbalance
- Fluid Replacement
- Recreational Drug Use
- Bolus