Pathophysiology of fluid translocation in hypovolemic state.

The broad meaning of "trauma" includes: 1)tissue injury, 2)inflammatory reaction, and 3)hypovolemic state. There are two arms of body response to "trauma": 1)neuro-hormonal and 2)konins-cytokines related. In both, compensation of hypovolemia is basic, but transmission of inflammatory mediators is dependent on appearanced hypervolemic tendency and related to augmented lymph flow. The course of after-injury fluids translocations consists of three phases: 1. "hemorrhagic", 2. sequestration, and 3. mobilization. The sequence of these phases is constant but duration is variable and depends on severity of trauma. Increased internal translocations of water, electrolytes and protein are required, leading to restoration of effective arterial blood volume and disappearance of baroreceptors irritation. The phase of compulsory sequestration of fluids involves all body fluid compartments. Distribution of fluid between intra- and extracellular compartments depends on the nature of "traumatic" stimulus: a) the more the tissue injury is related to hypovolemic-neurohormonal arm the more fluid is retained in the cells, b) the more the tissue injury is related to kinins-cytokines related arm the more is the expansion of extracellular compartment with increase in plasma volume and lymph flow. Hypoalbuminemia correlates inversely with the interstitial fluid volume. Sequestration phase is followed by fluid mobilization. Previously negative balance of water and natrium comes to null. In case of complications a new sequestration phase should be expected.