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Fluids, pH, ions and electrolytes

Kaplan, Lewis Ja; Kellum, John Ab

Current Opinion in Critical Care: August 2010 - Volume 16 - Issue 4 - p 323–331
doi: 10.1097/MCC.0b013e32833c0957
Intravenous fluids: Edited by Greg S. Martin

Purpose of review Significant attention has been recently focused on both maintenance fluid and resuscitation fluid use in critical care. Accordingly, a focused review of the properties of crystalloid and colloid fluids, their expected benefits, and potential deleterious side effects is appropriate and timely.

Recent findings Despite their ubiquitous use, well described side effects, and ability to be titrated to a physiologic endpoint, fluids are rarely considered in a fashion similar to other pharmacologic agents. Understanding their physical and chemical properties allows the clinician to understand, anticipate and deliberately harness their expected impact on acid–base balance. Expanded insights into the pathogenesis of common acid–base disorders may be gleaned from utilizing a physicochemical approach that allows the precise quantification of the ionic species that impact pH.

Summary This focused review further enables the clinician to appropriately investigate, modify, and optimize bedside clinical care related to fluid and acid–base management.

aYale University School of Medicine; Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies; New Haven, Connecticut, USA

bUniversity of Pittsburgh School of Medicine; Department of Critical Care Medicine; Pittsburgh, Pennsylvania, USA

Correspondence to John A. Kellum, MD, FCCM, FCCP, Department of Critical Care Medicine, University of Pittsburgh, 608 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA Tel: +1 412 647 0781; fax: +1 412 647 3791; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.