Acid-Base, Electrolyte and Fluid Alterations: Review

Background: Volume overload and fluid congestion remain primary clinical challenges in the assessment and management of patients with chronic heart failure (HF). Summary: The pathophysiology of volume regulation is complex, and the simple concept of passive intravascular fluid accumulation is not adequate. The dynamics of interstitial and intravascular fluid compartment interactions and fluid redistribution from venous splanchnic beds to the central pulmonary circulation need to be taken into account in strategies of volume management. Clinical bedside evaluations and right heart hemodynamic assessments can alert of changes in volume status, but only the quantitative measurement of total blood volume can help identify the heterogeneity in plasma volume and red blood cell mass that are features of volume overload in chronic HF. The quantitative assessment of intravascular volume is an effective tool to help guide individualized, appropriate therapy. Key Message: Not all volume overload is the same, and the measurement of intravascular volume identifies heterogeneity to guide tailored therapy. © 2016 S. Karger AG, Basel Received: August 19, 2016 Accepted after revision: September 1, 2016 Published online: October 12, 2016 Wayne L. Miller, MD, PhD Department of Cardiovascular Diseases, Mayo Clinic 200 First Street, SW Rochester, MN 55905 (USA) E-Mail miller.wayne @ mayo.edu © 2016 S. Karger AG, Basel 2296–9381/16/0024–0164$39.50/0