Acute Hypoproteinemic Fluid Overload: Its Determinants, Distribution, and Treatment with Concentrated Albumin and Diuretics

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Abstract
The use of massive volumes of crystalloid fluids as a treatment of acute plasma loss was simulated in a standardized experimental model and the factors determining the retention or excretion of the resulting acute hypoproteinemic fluid overload, its distribution within the body, and its treatment with concentrated albumin and diuretics were studied. In accordance with the classic Starling concept, the serum protein level, i.e., the serum colloid osmotic pressure, determined the excretion/retention ratio of a given water and Na load. Of the total fluid retention, fat and muscle each accommodated 25%, but the skin, which contributes only 7% to the total body weight, accounted for 37% and increased its volume by roughly 1/3. Concentrated albumin promoted fluid excretion in direct proportion to the achieved increment of the serum protein level and abolished the edema of fat, muscle and skin. Furosemide was virtually ineffective. The implications of these results for the adult respiratory distress syndrome and disturbed wound healing are discussed and related to the concept of a critical threshold of the serum protein level.