Fluid_Management_in_Preeclampsia (4).pdf - CMQCC...

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CMQCC PREECLAMPSIA TOOLKIT PREECLAMPSIA CARE GUIDELINES CDPH-MCAH Approved: 12/20/13 FLUID MANAGEMENT IN PREECLAMPSIA Tom Archer, MD, MBA, University of California, San Diego Holly Champagne, MSN, RNC, CNS, Kaiser Permanente, Roseville BACKGROUND Fluid management in preeclampsia is often difficult because of a leakage of water, electrolytes, and plasma from the intravascular space, due to underlying endolethial damage. This leakage can produce significant fluid shifts into the interstitial space resulting in peripheral and/or central (pulmonary and central nervous system, CNS) edema. As fluid shifts out of the intravascular space, there is also the potential for hypovolemia. Therefore, fluid administration must be assessed in the context of preserving organ perfusion, while limiting or preventing pulmonary edema. Renal endothelial damage appears to be particularly sensitive to these fluid changes resulting in proteinuria and oliguria. Assessment of renal function (serum creatinine) should be assessed to determine the degree of renal dysfunction. One hallmark of intravascular depletion is hemoconcentration. 1-4 Since pulmonary edema is more common and permanent renal damage due to preeclampsia is rare, fluids are normally restricted (see section related to Magnesium administration, pg. 50). 5 If oliguria occurs, a trial of intravenous (IV) fluid bolus of 250-500 ml isotonic fluid (normal saline or Lactated Ringer’s) can be given. If after a total infusion of 1000 ml of crystalloid

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