Continued replacement of further plasma loss

00000000Intravenous fluid is continued with the rate adjusted to the rate of plasma loss, as guided by haematocrit values and vital signs, for a period of 24-48 hours (as flow diagram in Figure 2). Establishment of central venous pressure and a urinary catheter may be necessary in the management of severe cases that are not easily reversible.

00000000 Colloidal fluid is indicated in cases with massive leakage and to whom a large volume of crystalloid fluid has been given.

00000000 In small children, five per cent dextrose in a half-strength normal saline solution (five per cent D/1/2 NSS) is used following initial resuscitation,
and five per cent dextrose in one-third strength normal saline solution (five per cent C/1/3 NSS) may be used in infants under one year of age, if the serum sodium is normal.

00000000 Intravenous fluid should be discontinued when the haematocrit reading drops to around 40 per cent and vital signs are stable. A good urine flow indicates sufficient circulating renal volume. A return of appetite and diuresis are signs of recovery. In general, there is no need for fluid therapy for more than 48 hours after onset of leakage and/or shock. Reabsorption of extravasated plasma takes place one to two days thereafter (manifested by a further drop in haematocrit after IV fluid has been stopped and clearing of pleural effusion and ascites has occurred) and may cause hypervolaemia, heart failure and pulmonary oedema if more fluid is given. It is extremely important to emphasize that a drop in haematocrit at this stage should not be interpreted as a sign of internal haemorrhage. Strong pulse and blood pressure with wide pulse pressure and diuresis are good vital signs during this reabsorption phase. All of these good signs will help to rule out the likelihood of gastro-intestinal haemorrhage, which is found mostly during the shock stage.