The human body is composed of different fluid compartments and each compartment is important in regards to fluid resuscitation; however, each compartment must work in cohesion with the other. The fluid compartments consist of the Intracellular Fluid Compartment (ICF), the Extracellular Fluid Compartment (ECF), the intravascular space, and the interstitial space.
The Intracellular Fluid Compartment contains about two-thirds of the body’s total fluid or 66% according to the manual of Critical Care; whereas the Extracellular compartment consists of one-third or 33% our total fluid.
When assessing the patient the healthcare provider should use their critical thinking skills to determine the fluid needs of the patient; which fluid compartments are or will be affected, and what types of fluids would best be ordered to help achieve an optimal fluid distribution. The human body’s serum osmolarity typically ranges from 285-295 in order to maintain homeostasis in these fluid compartments. There has been a lot of debate over this particular issue in the healthcare setting for quite some time. In order to be effective in managing the redistribution of fluids the healthcare provider must understand what types of fluids are either crystalloids and or colloids and how that may affect the movement of fluids across the different compartment membranes.
Before selecting a colloid versus a crystalloid the healthcare provider must paint an overall picture of the patient’s condition and underlying disease process. According to the Tabers Medical Dictionary a Crystalloid is a solution in which crystals can or may form; but is able to diffuse across cellular membranes. Again, according to Tabers Medical Dictionary a colloid is a “glue-like substance, such as a protein or starch… or a substance used as a plasma expander in place of blood.” (Wilbur, 2009) The following are some examples of colloid solutions. The goal of fluid resuscitation is to hydrate the cells in order to maintain a normal blood pressure and pulse rate.
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However, if the water in our bodies is not distributed correctly it can have a detrimental impact on the patient’s outcome.
The Extracellular compartment may be broken down further into the intravascular space and interstitial spaces. Distribution of fluids will depend on the solute order and the concentration of said solute. The healthcare provider should assess the osmolarity of the crystalloids or colloids in order to help determine where and how they want to move the fluids from one compartment to another.
The physician may choose to select a colloid for patients who are already deemed to be in pulmonary edema or have some type of cardiac issue that may hinder an effect fluid exchange at the capillary level.


The amount of expansion it provides to the vascular system depends on the amount and rate of infusion.
There are many methods to monitor and asses a patient’s fluid status; however it is difficult to pinpoint the exact amount of fluid loss. Both crystalloids and colloids have their place in fluid resuscitation, but the healthcare provider must look at the overall picture and use critical thinking skills in order to administer the correct fluids, at the correct rate, and the correct amount. By given colloids the healthcare provider can limit the fluid intake; yet still achieve fluid resuscitation.
Hetastarch is composed of 154 mEq’s of Sodium with a ph level of 5.5 as well as an osmolarity of 310. The problem is it takes a larger amount of crystalloids to resuscitate a patient fully; on the other hand it only takes a small amount of colloids. Healthcare providers may choose to perform a venipuncture and obtain a serum osmolarity or the physician may opt to insert a central line a monitor the patients central venous pressure (CVP) otherwise known as right atrium pressure. The healthcare provider should assess the patient and determine the goal of the fluid resuscitation needed and then make a decision on the correct fluid to administer. On the flip side if the patient has not yet gone into full blown pulmonary edema and has good kidney function the provider may opt for the crystalloid as this is less expensive and research has determined that neither has an advantage over the other; except cost. Albumin 5% is composed of 154 mEq’s of Sodium and 50 grams of Albumin and has a ph level of 6.6 as well as an osmolarity of 290. Dextran 40 is composed of 154 mEq’s Sodium, a ph level of 6.7, as well as an osmolarity of 320.
The healthcare provider should also look at the risk versus the benefits as well as the cost analysis. Crystalloids are less expensive than colloids; so the healthcare provider should outweigh the benefits versus the risk as well as a simple cost analysis.
Whereas Dextran 70 is composed of 154 mEq’s Sodium, a ph level of 6.3, and an osmolarity of 310. Depending on what the patient’s medical condition is and the end goal of the fluid resuscitation will depend on whether the healthcare provider administers a crystalloid or colloid.
The lower the CVP the more dehydrated the patient may be; whereas the higher the CVP the patient will most likely present with fluid overload. Saline doubt, d50w certain 5 can meaning dextrose use will solution thy 5 line stadion barcelona drugs, 0.45 is or macfie.


For example if a patient arrives to the emergency room or ICU and as in hypovolemic shock; the goal of fluid replacement would most likely be attained by administering a crystalloid.
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On the other hand if the patient is septic and has been diagnosed with septic shock the provider may give a colloid or crystalloid.
The higher the serum osmolarity the more dehydrated the patient may present; whereas the higher the serum osmolarity the more likely the patient will present with symptoms of fluid overload.
Another option that healthcare providers have at their disposal is the complete blood count (CBC).
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Comments

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