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Area of Science:

  • Anesthesiology
  • Fluid Physiology
  • Pharmacokinetics

Background:

  • The existence of a "third fluid space" has been debated in anesthesiology for over 50 years.
  • This concept refers to fluid accumulating in a body compartment not readily exchanging with plasma.

Purpose of the Study:

  • To investigate the kinetics of crystalloid fluid distribution.
  • To challenge the concept of the "third fluid space" using fluid kinetic analysis.

Main Methods:

  • Population volume kinetic analysis of hemodilution data from volunteers and surgical patients.
  • Modeling fluid elimination via urinary excretion and "third space" accumulation.

Main Results:

  • "Third space" accumulation accounted for 20% of fluid elimination in volunteers and 75% during anesthesia and surgery.
  • Fluid in the "third space" increases when urinary excretion is restricted.
  • One-third of infused crystalloid fluid can be temporarily held in the "third space" during surgery.

Conclusions:

  • A significant portion of infused crystalloid fluid is temporarily unavailable for excretion during anesthesia and surgery.
  • This temporary fluid sequestration likely contributes to postoperative weight gain and edema.