A general goal for all fluid administration is the restoration of intravascular volume. However, a second goal may be to ensure good oxygenation of the blood with an appropriate level of haemoglobin. Up to a decrease in haemoglobin of 5 mmol/l, crystalloid fluids are preferred. Beyond this, packed cells or other blood products can be administered. Fluids are subdivided into crystalloid (similar osmolality to intravascular volume) and colloid (expand intravascular volume) solutions. The most commonly used crystalloids for hypovolaemic shock are normal saline or lactated Ringer's solution. Colloid solutions include 5% albumin
and Voluven (heta-starch). The benefits of one type of fluid replacement therapy versus another have not been established. Due to the expansive nature of colloid solutions, smaller volumes of these agents are required.
A patient is transferred to the emergency unit after a severe accident. He suffers from extensive bleedings and his hematocrit has dropped below 30%. Which infusion is appropriate at this stage?
Extra info: With a haematocrit below 30%, the transport capacity of oxygen is seriously reduced. So, addition of erythrocytes is necessary to guarantee oxygen transport.
A patient with severe hypovolaemic shock after myocardial infarction is transferred to the emergency unit. Her Hb is normal. Which infusion is appropriate at this stage?
Extra info: There is no absolute preference for a specific fluid. The goal is to increase volume this can be achieved by all options mentioned.