Laboratory Considerations

UOP may not be a reliable indicator of adequate resuscitation in some patients. Monitor hematocrit and lactate (and/or base deficit) as well. Successful resuscitation is indicated by resolution of hemoconcentration (e.g., hematocrit > 30%) and normalization of lactate.

Special considerations that increase fluid requirements in the first 24 hours:

- Hyperglycemia
- Illicit substance use
- Diuretics
- Alcohol
- Mechanical ventilation
- Additional trauma
- Preexisting dehydration
- Sedation or general anesthesia

Indicators of completed resuscitation:

- Patient follows commands
- Restoration of hemodynamics with minimal vasopressor requirement
- Adequate UOP of 30-50mL/hr
- Minimal fluid requirement
- Resolution of metabolic acidosis
- Hematocrit low to normal range (no further evidence of hemoconcentration)

If possible, measure bladder pressures every 4 hours in intubated patients if fluid resuscitation volumes during the first 24 hours are >200 mL/kg.5 Ensure the patient is in the supine position and follow the manufacturer's instructions for commercial kits; otherwise, use between 25 and 50 ml, being consistent in whatever volume is used, for serial measurements using a transducer located at the level of the symphysis pubis. Sustained bladder pressure >12 mmHg indicates early intra-abdominal hypertension and adjuncts such as colloid fluid should be considered for ongoing resuscitation. If the measured pressure is >20 mmHg, the patient should be fully sedated and paralyzed, and the measurement repeated. Persistent bladder pressures >20 mmHg may indicate abdominal compartment syndrome. (See Abdominal Compartment Syndrome below.)