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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
"blood loss"
symptom
adrenal incidentaloma
cholangiocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
heparin-induced thrombocytopenia
hirschsprung disease
sneddon syndrome
systemic capillary leak syndrome
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