目的:美国国家健康与护理卓越研究所(NICE)的成人医院维持液体治疗指南被广泛使用,但是这些建议没有得到适当的评估。在这项研究中,我们调查了提供25-30mL/kg/天的液体和1mmol/kg钠和钾的建议是否足以满足人类需求.
方法:首先,我们计算了在交叉输注实验期间细胞外液体积(ECV)和细胞内液体积(ICV)之间的液体分布,其中12名志愿者在48小时内接受25毫升/千克的高钠(154毫摩尔/升)或低钠(54毫摩尔/升)溶液。719名志愿者和临床患者的尿液样本被用来量化他们的肾脏水保护和钠和钾的排泄。第三,对一项饮食研究的回顾性分析用于推断719名志愿者和接受尿液输送的医院患者的液体摄入量和电解质排泄可能有多大.
结果:高钠液维持ECV,但ICV在48小时后降低了1.3L。低钠液导致1.7L的体积不足,对ECV和ICV的影响相等。基于饮食研究的回归方程表明,719名受试者的每日平均饮水量为2.6L,排泄了2mmol/kg的钠和1mmol/kg的钾。
结论:NICE指南建议人类水和钠过少,无法充分维持ECV和ICV。
背景:EudraCT2016-001846-24和ISRCTN12215472。
OBJECTIVE: The National Institute for Health and Care Excellence\'s (NICE)
Guideline for Maintenance Fluid Therapy in Adults in Hospital is widely used, but the recommendations have not been evaluated properly. In this study, we investigated whether the recommendation of providing 25-30 mL/kg/day of fluid and 1 mmol/kg each of sodium and potassium is sufficient for human needs.
METHODS: First, we calculated the distribution of fluid between the extracellular fluid volume (ECV) and intracellular fluid volume (ICV) during a cross-over infusion experiment where 12 volunteers received 25 mL/kg/day of either a high-sodium (154 mmol/L) or low-sodium (54 mmol/L) solution over 48 h. Second, urine samples from 719 volunteers and clinical patients were used to quantify their renal water conservation and excretion of sodium and potassium. Third, retrospective analysis of a diet study was used to extrapolate how large the fluid intake and the electrolyte excretion likely had been in the 719 volunteers and hospital patients who delivered urine.
RESULTS: The high-sodium fluid maintained the ECV but the ICV had decreased by 1.3 L after 48 h. The low-sodium fluid resulted in a volume deficit of 1.7 L that equally affected the ECV and the ICV. Regression equations based on the diet study suggested that the daily intake of water in the 719 subjects averaged 2.6 L and that 2 mmol/kg of sodium and 1 mmol/kg of potassium was excreted.
CONCLUSIONS: The NICE
guideline recommends too little water and sodium for a human to adequately maintain the ECV and ICV.
BACKGROUND: EudraCT 2016-001846-24 and ISRCTN 12215472.