Crystalloid support of blood volume

Publisher Website
Google Scholar
Abstract
Full expansion of a contracted blood volume need not be achieved immediately. Moderate hypovolemia and increased sympathetic tone usually are well tolerated. A 3:1 replacement regimen of crystalloid for shed blood is reasonable for moderate losses by healthy individuals. Larger volumes of fluid are required to achieve full expansion, as would be desired prior to surgery. A minimum ratio of approximately 5:1 is expected on theoretical grounds, has been found experimentally, and is now reported for two patients with self‐limited hemorrhage of 1300 and 1400 ml. The ratio rises dramatically with progressive hypoalbuminemia, as in an older patient with perforated cecal carcinoma and peritonitis. Hemodynamic stability was maintained only after retention of 8000 ml of fluid to re‐expand a measured 840‐ml plasma deficit (9.5:1). Support of a contracted blood volume with massive volumes of fluid might be life‐saving under extraordinary conditions. It is deplored otherwise, because of detrimental physiological and metabolic effects of unconnected hypoalbuminemia and edema.