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Understanding Volume Kinetics: The Role of Pharmacokinetic Modeling and Analysis in Fluid Therapy
Frontiers in Veterinary Science ( IF 3.2 ) Pub Date : 2020-10-12 , DOI: 10.3389/fvets.2020.587106
Xiu Ting Yiew 1 , Shane W Bateman 1 , Robert G Hahn 2, 3 , Alexa M E Bersenas 1 , William W Muir 4
Affiliation  

Fluid therapy is a rapidly evolving yet imprecise clinical practice based upon broad assumptions, species-to-species extrapolations, obsolete experimental evidence, and individual preferences. Although widely recognized as a mainstay therapy in human and veterinary medicine, fluid therapy is not always benign and can cause significant harm through fluid overload, which increases patient morbidity and mortality. As with other pharmaceutical substances, fluids exert physiological effects when introduced into the body and therefore should be considered as “drugs.” In human medicine, an innovative adaptation of pharmacokinetic analysis for intravenous fluids known as volume kinetics using serial hemoglobin dilution and urine output has been developed, refined, and investigated extensively for over two decades. Intravenous fluids can now be studied like pharmaceutical drugs, leading to improved understanding of their distribution, elimination, volume effect, efficacy, and half-life (duration of effect) under various physiologic conditions, making evidence-based approaches to fluid therapy possible. This review article introduces the basic concepts of volume kinetics, its current use in human and animal research, as well as its potential and limitations as a research tool for fluid therapy research in veterinary medicine. With limited evidence to support our current fluid administration practices in veterinary medicine, a greater understanding of volume kinetics and body water physiology in veterinary species would ideally provide some evidence-based support for safer and more effective intravenous fluid prescriptions in veterinary patients.



中文翻译:

了解体积动力学:药代动力学建模和分析在液体治疗中的作用

液体治疗是一种快速发展但不精确的临床实践,基于广泛的假设、物种间的推断、过时的实验证据和个人偏好。尽管液体疗法被广泛认为是人类和兽医学的主要治疗方法,但液体疗法并不总是良性的,并且可能因液体超负荷而造成严重伤害,从而增加患者的发病率和死亡率。与其他药物一样,液体进入体内后会产生生理作用,因此应被视为“药物”。在人类医学中,二十多年来,一种使用连续血红蛋白稀释和尿量的静脉液体药代动力学分析的创新方法(称为体积动力学)已经得到开发、完善和广泛研究。现在可以像药物一样研究静脉液体,从而更好地了解其在各种生理条件下的分布、消除、容量效应、功效和半衰期(作用持续时间),从而使基于证据的液体治疗方法成为可能。本文介绍了体积动力学的基本概念、其目前在人类和动物研究中的应用,以及其作为兽医液体治疗研究工具的潜力和局限性。由于支持我们目前兽医输液实践的证据有限,对兽医物种的体积动力学和体液生理学有更深入的了解将理想地为兽医患者提供更安全、更有效的静脉输液处方提供一些循证支持。

更新日期:2020-11-21
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