Adequate volume and fluid therapy is part of very many anaesthesiological, intensive and emergency medical treatments. Patients require intravascular volume therapy “e.g. peri-operatively or peri-interventionally when fasting is medically recommended, or when the enteral fluid absorption rate falls below the necessary substitution rate, e.g. in shock, with large fluid turnover in the context of major surgery, or with reduced enteral absorption as a result of prolonged vomiting or severe diarrhoeaˮ.[1]
In the case of volume replacement solutions, a distinction must be made between crystalloid and colloid solutions. Crystalloid solutions disperse in the intravascular space as well as in the interstitium, and are used for fluid and volume replacement, whereby the volume effect and the intravascular retention time are lower than with colloidal solutions. Colloidal solutions, on the other hand, contain oncotically active macromolecules, tend to remain longer and in larger quantities in the intravascular space and are mainly used for volume replacement. However, the use of colloids such as HES and gelatin solutions has been controversial from a medical point of view for a number of years, hence colloids are seldom used these days. Compared with artificial colloids such as HES and gelatin solutions, the medical value of human albumin (natural colloid) is higher. Although it is also used much less frequently than crystalloid solutions, human albumin must is available, especially for volume replacement in cases of rapid, high blood/plasma loss and hypoalbuminemia. Within the group of crystalloid solutions, the administration of balanced whole electrolyte solutions is preferable to the use of 0.9% sodium chloride solution, as negative effects (hyperchloraemic acidosis) can occur when sodium chloride solution is used because it has a higher chloride content than human plasma and lacks bicarbonate precursors.
Based on the results of this analysis, it is recommended that electrolyte solutions (ATC code B05BB01) as well as solutions with albumin (ATC code B05AA01) be subject to mandatory reporting.
[1] ‘S3-Leitlinie Intravasale Volumentherapie beim Erwachsenen’, published by the Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, page xi. Available online at https://www.awmf.org/uploads/tx_szleitlinien/001-020l_S3_Intravasale-Volumentherapie-Erwachsene_2020-10.pdf (in German).
