The blood pressure is low, give a bolus of fluids. Many times that leads to a “nurse dose” as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or passive leg raise you gave/performed on your patient. It doesn’t mean that you gave the amount of fluid and the blood pressure got better. After all, patients extravasate a considerable amount of fluid within one hour of receiving it, especially in critically ill patients. Essentially we are causing IV fluid overload on many of our patients.

Giving too much fluid causes harm. Sure, it’s as easy as placing an order in the computer and hanging another bag, and we do feel like we “did something”, but matter cannot be created nor destroyed, and said fluid will cause harm if not indicated. There are serious consequences to this indiscriminate utilization of fluids to treat ourselves rather than the patient.

The paper cited by Dr. Marik breaks down in detail from a physiologic perspective using fancy words that the lay healthcare professional won’t understand the first time they read the FREE paper such as “natriuretic peptides cleave membrane- bound proteoglycans and glycoproteins”, but the foundations of understanding are there for you and I to learn from. I definitely recommend you read it from his paper rather than trusting me on the matter.

Effects of IV Fluid Overload

The following list is directly from the paper:
“Consequences of volume overload
Pulmonary edema and increased extra-vascular lung water
– Impaired oxygenation
– Altered pulmonary and chest wall mechanics
– Increased work of breathing

Myocardial edema
– Decreased contractility
– Diastolic dysfunction
– Conduction defects

Increased intraabdominal pressure
– Acute kidney injury
– Hepatic dysfunction
– Decreased lung volumes
– Ileus

Gastrointestinal
– Ileus
– Malabsorption
– Bacterial translocation
– Hepatic congestion
Decreased wound healing”

The patient will surely have some negative signs and symptoms from this IV fluid overload such as shortness of breath, weakness, fatigue, abdominal tightness and pain, bloating, leg swelling, and others.

I have covered, and will continue to cover, in other posts on my blog, instagram, and website how to more appropriately provide fluids to our patients who need them during the time of resuscitation.
-EJ

If you care for more information, I have broken down Resuscitation and Fluid responsiveness here. I have also broken down the types of IV fluids in detail here.

Citation:

Marik PE. Iatrogenic salt water drowning and the hazards of a high central venous pressure. Ann Intensive Care. 2014;4:21. Published 2014 Jun 21. doi:10.1186/s13613-014-0021-0
Link to Abstract
Link to FULL FREE Article

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