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Pathophysiology of fluid imbalance.
[systemic capillary leak syndrome]
Fluid
imbalance
can
arise
due
to
hypovolemia
,
normovolemia
with
maldistribution
of
fluid
,
and
hypervolemia
.
Trauma
is
among
the
most
frequent
causes
of
hypovolemia
,
with
its
often
profuse
attendant
blood
loss
.
Another
common
cause
is
dehydration
,
which
primarily
entails
loss
of
plasma
rather
than
whole
blood
.
The
consequences
of
hypovolemia
include
reduction
in
circulating
blood
volume
,
lower
venous
return
and
,
in
profound
cases
,
arterial
hypotension
.
Myocardial
failure
may
result
from
increased
myocardial
oxygen
demand
in
conjunction
with
reduced
tissue
perfusion
.
Finally
,
anaerobic
metabolism
due
to
reduced
perfusion
may
produce
acidosis
and
,
together
with
myocardial
dysfunction
,
precipitate
multi-organ
failure
.
The
splanchnic
organs
are
particularly
susceptible
to
the
deleterious
effects
of
hypotension
and
hypovolemic
shock
,
and
these
effects
,
depending
upon
their
duration
and
severity
,
may
be
irreversible
despite
restoration
of
normovolemia
by
fluid
administration
.
Patient
monitoring
in
the
intensive
care
unit
typically
relies
upon
central
venous
pressure
devices
,
whereas
the
primary
focus
in
the
operating
theater
is
blood
volume
deficit
estimated
from
suction
devices
.
However
,
estimates
of
intraoperative
blood
loss
can
be
inaccurate
,
potentially
leading
to
inappropriate
fluid
management
.
Normovolemia
with
maldistribution
of
fluid
can
be
encountered
in
shock-
specific
microcirculatory
disorders
secondary
to
hypovolemia
,
as
well
as
pain
and
stress
.
Consequent
vasoconstriction
and
reduced
tissue
driving
pressure
,
as
well
as
leukocyte
and
platelet
adhesion
,
and
liberation
of
humoral
and
cellular
mediators
,
may
impair
or
abolish
blood
flow
in
certain
areas
.
The
localized
perfusion
deficit
may
contribute
to
multi-organ
failure
.
Choice
of
resuscitation
fluid
may
be
important
in
this
context
,
since
some
evidence
suggests
that
at
least
certain
colloids
might
be
helpful
in
diminishing
post-ischemic
microvascular
leukocyte
adherence
.
Excessive
volume
administration
may
lead
to
fluid
overload
and
associated
impairment
of
pulmonary
function
.
However
,
entry
of
fluid
into
the
lungs
may
also
be
facilitated
by
increased
vascular
permeability
in
certain
pathologic
conditions
,
especially
sepsis
and
endotoxemia
,
even
in
the
absence
of
substantially
rising
hydrostatic
pressure
.
Another
condition
associated
with
elevated
vascular
permeability
is
systemic
capillary
leak
syndrome
.
The
chief
goal
of
fluid
management
,
based
upon
current
understanding
of
the
pathophysiology
of
fluid
imbalance
,
should
be
to
ensure
adequate
oxygen
delivery
by
optimizing
blood
oxygenation
,
perfusion
pressure
,
and
circulating
volume
.
Diseases
Validation
Diseases presenting
"dehydration"
symptom
aniridia
esophageal carcinoma
familial hypocalciuric hypercalcemia
harlequin ichthyosis
homocystinuria without methylmalonic aciduria
junctional epidermolysis bullosa
lamellar ichthyosis
systemic capillary leak syndrome
This symptom has already been validated