The Challenge of Perioperative Fluid Management in Elderly Patients
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Purpose of Review
The purpose of this chapter is to describe physiological changes occurring with age relevant to fluid therapy, and to discuss the influence of fluid therapy on outcome of surgery from this perspective.
Dehydration, common among elderly people, is often mistaken for dementia or depression. Dehydration with dizziness increases the risk of falling, a predictor for adverse outcomes after surgery.
Young volunteers can excrete up to 300 mmol sodium per liter urine. Elderly people cannot achieve such a concentration emphasizing the importance of giving water to excrete the osmoles given with intravenous crystalloids.
Brain natriuretic peptide increases in cardiac disease and with age. Preoperative elevated levels predict adverse outcomes following surgery.
The evidence and the physiology show that elderly patients benefit from a thorough regulation of fluid therapy keeping fluid balance close to zero (no more than 2 l positive) and with sufficient glucose and water supply.
KeywordsDehydration Kidney function Salt excretion Urine concentration Sodium excretion Fluid therapy Restricted fluid therapy Zero-balance fluid therapy Fluid overload Complications Surgery Abdominal surgery Gastrointestinal surgery N-terminal pro-B natriuretic peptide Cardiac complications Changes with age Elderly patients
Compliance with Ethical Standards
Conflict of Interest
Birgitte Brandstrup and Ann M. Møller declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any new data studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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