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Plasma volume replacement fluids

Arguments over the best type of fluid for volume resuscitation have been ongoing for more than 30 years.

Data from clinical trials suggests no therapeutic advantage for either crystalloids or colloids. Physiologically balanced crystalloid and colloid solutions may improve clinical outcomes when compared with saline-based fluids.(1)

Characteristics of Different Types of Plasma Volume Replacement Fluids
Plasma Volume Replacement Fluid Characteristics Indications
Crystalloid solutions
Normal saline (sodium chloride 0.9%)
Ringers lactate
Hartmann’s solution
  • Contain a similar concentration of sodium to plasma. Distributed through the whole extracellular compartment.
  • Normally only a quarter of the volume infused remains in the vascular compartment.
  • Need to infuse at least three times the volume lost in order to correct hypovolaemia.

Used to replace abnormal losses of blood, plasma or other extracellular fluids principally in:

  • Treatment of patients with established hypovolaemia
    • Eg, haemorrhagic shock
  • Maintenance of normovolaemia in patients with ongoing fluid losses
    • Eg, surgical blood loss
Colloid solutions
Gelatin (urea linked), eg Haemacel Gelatin (succinylated), Gelofusine Dextran 70 (6%)
Dextran 60 (3%)
Hydroxyethyl starch (N/A in Australia)
Albumin solutions, eg Albumex 4
  • Initially tend to remain within the vascular compartment.
  • Mimic plasma proteins, thereby maintaining or raising the colloid osmotic pressure of blood.
  • Provide longer duration of plasma volume expansion than crystalloid solutions.
  • Require smaller infusion volumes—infuse volume equal to blood volume deficit.

Replacement of blood volume, however have not been shown to be superior to crystalloids in resuscitation.

 

Higher cost.

 

May cause volume overload.
Maintenance fluids
5% Glucose
4% Glucose in 0.18% sodium chloride
  • Composed mainly of water in a dextrose solution, however may contain some electrolytes.
  • The volume of maintenance fluids required by a patient will vary, particularly with fever, high ambient temperature or humidity; when losses will increase.

Used to replace normal physiological losses through the skin, lung, faeces and urine.

 

Do not use to treat hypovolaemia unless there is no alternative.

Reference

  1. Grocott MPW, Hamilton MA. Resuscitation fluids. Vox Sanguinis 2002;82(1):1–8.
Updated on 12 September 2011