Electrolytes and plasma volume regulation in hypovolemic shock

The concept of hypovolemic shock and its effects on plasma volume were described in the 1700s. It has been left for more recent investigators to elucidate the role of plasma volume and its mechanisms of regulation and interaction with the interstitial and intracellular fluid spaces. These interactions are discussed, and a therapeutic regimen of fluid administration based on a clinical classification of hypovolemic hemorrhagic states is presented. The merits and characteristics of the current fluids available for resuscitation are reviewed. The choices of fluid for resuscitation should be made with the overall goal of an efficient and effective restoration of circulating volume without producing excessive, avoidable, potentially harmful distortion of other organ systems and body fluid compartments.