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  • Print publication year: 2010
  • Online publication date: July 2010

Chapter 29 - Failure of oxygenation

from Section III: - Organ dysfunction and management


Fluid and electrolyte balance is an important everyday practice on the intensive care unit. The different types of fluids are crystalloids that include Hartmann's solution, normal (isotonic) saline, dextrose, and colloids that include albumin, starch and gelatins. The disorders of sodium concentration are nearly always caused by excess free water (hyponatraemia) or free water loss (hypernatraemia). The potassium balance is affected by hypokalaemia and hyperkalaemia. The abnormalities in magnesium are caused by hypomagnesaemia and hypermagnesaemia. The abnormalities in phosphorous are caused by hypophosphataemia and hyperphosphataemia. The abnormalities in calcium are caused by hypocalcaemia and hypercalcaemia. Hypercalcaemia is not a common problem in intensive care. In 90% of cases, the underlying cause is hyper-parathyroidism or malignancy. Treatment is indicated when the hypercalcaemia is associated with adverse effects, or when the serum calcium is greater than 14 mg/dl (ionized calcium above 3.5 mmol/l).

Further reading

Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N. Engl. J. Med. 342: 1301–8.
BernardGR, ArtigasA, BrighamKLet al. (1994) The American–European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am. J. Resp. Crit. Care Med. 149: 818–24.
British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group (2003) British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 58: 470–84.
EichackerPQ,GerstenbergerEP, BanksSM, CuiX, NatansonC (2002) Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am. J. Resp. Crit. Care Med. 166: 1510–14.
Jerjes-SanchezC, Ramirez-RiveraA, GarciaMMet al. (1995) Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomised controlled trial. J. Thromb. Thrombolysis 2: 227–9.
MoloneyED, GriffithsMJD (2004) Protective ventilation of patients with acute respiratory distress syndrome. Br. J. Anaesth. 92: 261–70.
PinskyM, BrochardL, ManceboJet al. (2006) Applied Physiology in Intensive Care Medicine, 2nd edn. New York: Springer-Verlag.
SimonneauG, SorsH, CharbonnierBet al. (1997) A comparison of low molecular-weight-heparin with unfractionated heparin for acute pulmonary embolism: The THESEE Study Group. N. Engl. J. Med. 337: 663–9.
VincentJL (2006) DO2 /VO2 relationships In Functional Hemodynamic Monitoring, eds. PinskyMR, PayenD.Basel, Switzerland: Birkhaüser, pp. 251–257.
WareLB, MatthayMA (2000) The acute respiratory distress syndrome. N. Engl. J. Med. 342: 1334–48.