Kilic Ozgur, Gultekin Yucel, Yazici Selcuk
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology Department, Cardiac Intensive Care Unit, Istanbul, Turkey.
Mersin University Hospital, General Surgery Department, Mersin, Turkey.
Int J Nephrol Renovasc Dis. 2020 Sep 30;13:219-230. doi: 10.2147/IJNRD.S266864. eCollection 2020.
One of the most important tasks of physicians working in intensive care units (ICUs) is to arrange intravenous fluid therapy. The primary indications of the need for intravenous fluid therapy in ICUs are in cases of resuscitation, maintenance, or replacement, but we also load intravenous fluid for purposes such as fluid creep (including drug dilution and keeping venous lines patent) as well as nutrition. However, in doing so, some facts are ignored or overlooked, resulting in an acid-base disturbance. Regardless of the type and content of the fluid entering the body through an intravenous route, it may impair the acid-base balance depending on the rate, volume, and duration of the administration. The mechanism involved in acid-base disturbances induced by intravenous fluid therapy is easier to understand with the help of the physical-chemical approach proposed by Canadian physiologist, Peter Stewart. It is possible to establish a quantitative link between fluid therapy and acid-base disturbance using the Stewart principles. However, it is not possible to accomplish this with the traditional approach; moreover, it may not be noticed sometimes due to the normalization of pH or standard base excess induced by compensatory mechanisms. The clinical significance of fluid-induced acid-base disturbances has not been completely clarified yet. Nevertheless, as fluid therapy may be the cause of unexplained acid-base disorders that may lead to confusion and elicit unnecessary investigation, more attention must be paid to understand this issue. Therefore, the aim of this paper is to address the effects of different types of fluid therapies on acid-base balance using the simplified perspective of Stewart principles. Overall, the paper intends to help recognize fluid-induced acid-base disturbance through bedside evaluation and choose an appropriate fluid by considering the acid-base status of a patient.
在重症监护病房（ICU）工作的医生最重要的任务之一是安排静脉输液治疗。ICU中需要进行静脉输液治疗的主要指征是复苏、维持或补充，但我们也会为了诸如液体缓慢输注（包括药物稀释和保持静脉通路通畅）以及营养等目的而输注静脉液体。然而，在这样做的过程中，一些事实被忽视或忽略了，从而导致酸碱平衡紊乱。无论通过静脉途径进入体内的液体的类型和成分如何，根据给药的速率、体积和持续时间，它都可能损害酸碱平衡。借助加拿大生理学家彼得·斯图尔特提出的物理化学方法，更容易理解静脉输液治疗引起酸碱平衡紊乱的机制。利用斯图尔特原理可以在液体治疗和酸碱平衡紊乱之间建立定量联系。然而，用传统方法无法做到这一点；此外，由于代偿机制导致pH值或标准碱剩余正常化，有时可能不会被注意到。液体引起的酸碱平衡紊乱的临床意义尚未完全阐明。尽管如此，由于液体治疗可能是导致无法解释的酸碱紊乱的原因，这可能会导致混淆并引发不必要的检查，因此必须更加关注以理解这个问题。因此，本文的目的是从斯图尔特原理的简化角度探讨不同类型的液体治疗对酸碱平衡的影响。总体而言，本文旨在通过床边评估帮助识别液体引起的酸碱平衡紊乱，并通过考虑患者的酸碱状态来选择合适的液体。
