Fluid management

Regarding peri-operative fluid management, which one of the following statements is MOST CORRECT?

a) In patients with acute kidney injury, potassium-containing balanced electrolyte solutions should be avoided

b) Higher molecular weight hydroxyethyl starch solutions should be avoided in severe sepsis

c) For patients with acute kidney injury, if free water is required 5% dextrose solution should be avoided

d) In patients without gastric emptying disorders, oral water is acceptable preoperatively except in the last hour prior to induction of anaesthesia

e) Elderly patients are more likely to benefit from 4% dextrose/0.18% saline fluid as maintenance

Answer: b

Explanation

Hetastarch or pentastarch solutions with an average molecular weight >200kDa have been shown to increase the risk of precipitating renal failure in severe sepsis. Patients with acute kidney injury should have their fluid and electrolyte status regularly reviewed, therefore the use of balanced electrolyte solutions is not prohibited as its advantages over 0.9% saline are still present. If a free-water deficit is demonstrable then 0.18% saline or 5% dextrose should be used but with vigilance to avoid hyponatraemia. The risks of hyponatraemia in children is well publicised; however, the elderly are equally susceptible and hypotonic and/or hyposmolar intravenous infusions as maintenance should be avoided (4% dextrose/0.18% saline is hypotonic but isosmolar). There is high-grade evidence that fasting times for oral non-particulate clear fluids should not exceed two hours in order to reduce peri-operative complications. The GIFTASUP 2008 guidelines (see reference below) give a t horough summary.

Reference

Powell-Tuck J, Gosling P, Lobo DN, et al. British consensus guidelines on intravenous

fluid therapy for adult surgical patients (GIFTASUP). 2008. Online at www.ics.ac.uk/

icmprof/standards.asp?menuid=7 (Accessed 30 October 2009)