A. S. Minot

The correction of distorted fluid equilibrium in the presence of vascular injury

Summary Restoration and maintenance of a normal amount of fluid and electrolytes in the body and a normal partition of the total body water comprise an important part of adequate supportive treatment. A normal partition of extracellular water in the blood stream and interstitial spaces is only possible when an adequate amount of plasma protein is present in the blood stream. In nutritional hypoproteinemia or following a loss of plasma protein through injured capillaries there is a distortion of fluid distribution in that too little is retained in the blood stream and too much accumulates in the tissue spaces. Thus edema of the tissues and dehydration of the blood may occur simultaneously. When plasma protein is deficient, the administration of fluid alone fails as a means of restoring an adequate volume of blood. Indeed such measures often result in a greater loss of protein through injured capillaries. A useful early sign that fluid administration is leading to this undesirable result is the observation of a gain in weight accompanied by a progressive rise in the concentration of hemoglobin and a decrease in the concentration of plasma protein. Proper supportive treatment for such patients must include a replacement of plasma protein as well as of fluid and electrolytes. Better results in terms of retention of the replaced protein and hence of the replaced fluid in the blood stream are obtained when early liberal transfusions of plasma are combined with a conservative administration of fluid.