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The history of intravenous therapy in children, focusing on the origins of IV fluid therapy and the debate surrounding the existence of a third space. It also discusses the risks of postoperative hyponatremia associated with IV fluid therapy. insights into historical milestones in intravenous therapy, the concept of third space losses, and the implications of perioperative fluid shift.
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P E G G Y P. M C N A U L L , M D A S S I S T A N T P R O F E S S O R , A N E S T H E S I O L O G Y A N D P E D I A T R I C S U N I V E R S I T Y O F N O R T H C A R O L I N A
Intravenous therapy – a historical perspective
1818 Blundell performed first human to human blood transfusion
1831 O’Shaughnessy published landmark article in Lancet about fluid and solute deficits in cholera victims
1832 Latta reported that he had successfully resuscitated numerous moribund cholera patients with intravenous water and salts
Intravenous therapy – a historical perspective
1918 Blackfan and Maxcy instilled 0.8% saline intraperitoneally to dehydrated infants
1931 Karelitz and Schick administered D5NS or D5LR intravenously via continuous infusion to dehydrated infants
1957 Holliday and Segar described the first practical method for the prescription of IV fluids
Refers to sequestration of fluid in a non-functional extracellular space that is beyond osmotic equilibrium with the vascular space Non-functional extracellular fluid volume (nfECV)
Functional extracellular fluid volume (fECV)
Acute change in extracellular fluids associated with major surgical procedures Annals of Surgery, 1961
Requires suitable tracer Requires appropriate equilibration time Requires multiple samples Requires steady state conditions
Utilized different tracers (i.e. Bromide) Calculated fECV from multiple blood samples Calculated fECV after longer equilibration times
Functional extracellular fluid volume (fECV)
Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomoses British Journal of Surgery, 1983
Received no IV fluid therapy Interstitial water load increased by 5-10%
Received 5 mL/kg/hr intraoperatively of crystalloid infusion Interstitial water load double that of Group 1
Surgical trauma increases
the protein permeability of the vascular endothelium Mechanical stress Endotoxin exposure Ischemia-reperfusion injury Inflammation
Acute hypervolemia from
liberal fluid therapy alters the endothelial glycocalyx
Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens Annals of Surgery, 2003
10 yo male trauma patient Intubated for respiratory distress Peri-intubation aspiration noted To OR for left foot ORIF 4 days mechanical ventilation for aspiration PNA Surgical team prescribed D5 ½ NS post transfer to floor Rapid response for acute mental status changes Tonic-clonic seizure while in the CT scanner Serum Na 116