Fluid balance and infection prevention in pre-eclampsia–eclampsia
THE CONTEXT
Fluid administration requires care because hypovolemia can coexist with tissue fluid overload in pre-eclampsia–eclampsia.
Fluid limits and infusion rate
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Total fluids should not exceed the previous 24 hours of urinary output plus 1000 mL for insensible losses through the lungs and skin.
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Normally, total fluids should not exceed 2 liters in 24 hours.
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The stated infusion rate for balanced salt solution is 1 mL/kg/h.
Overload and monitoring
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Excess dextrose or crystalloid solutions can aggravate tissue overload, leading to pulmonary edema and adult respiratory distress syndrome.
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Colloids such as albumin or hemaccel remain within the vascular tree and draw fluid from the interstitial space. Careless use can cause circulatory overload.
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CVP monitoring is needed when severe hypertension is accompanied by reduced urine output.
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Both PCWP and CVP appear to be low to normal in pre-eclampsia–eclampsia. Invasive hemodynamic monitoring is rarely indicated.
Infection prevention
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The passage specifies ceftriaxone 1 g intravenously twice daily to prevent infection.