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Fluid therapy: for intestinal obstruction

ISSN 2398-2950

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Pathophysiology

  • Fluid, electrolyte and acid-base imbalances occur via vomiting and sequestration into the bowel.
  • Prolonged obstruction results in a net secretion of water, sodium and potassium into the intestinal lumen.
  • Severity of water and electrolyte loss is greater the more proximal the obstruction.
  • Obstruction of the proximal duodenum may result in hypochloremia due to loss of chloride in vomitus, and metabolic alkalosis.
  • Obstruction distal to the duodenum may result in loss of bicarbonate and metabolic acidosis.

Treatment

Pre-operative

  • Restore fluid and electrolyte deficits rapidly so surgery is not delayed.
  • Hartmann's solution can be used until results of electrolyte and acid-base analysis are available.
  • Colloids or hypertonic saline may be superior to crystalloids because they remain in the circulation longer. Crystalloids may result in greater losses into the intestinal lumen.
  • Post-operative

  • Monitor hydration status and serum electrolytes and adjust treatment accordingly.
  • Supply fluids to match normal daily requirement plus continued abnormal losses.
  • May need to supplement potassium   Potassium chloride / gluconate  .

Further Reading

Publications

Refereed papers

Other sources of information

Johnson S E (1992) Fluid therapy for gastrointestinal, pancreatic, and hepatic disease. In: Fluid Therapy in Small Animal Practice. Ed S P DiBartola. Philadelphia: W B Saunders. pp 507-517.