Fluid and electrolyte overload in critically ill patients: An overview

Table 2 Potential complications of fluids and electrolytes overload

Organ system	Complication	Main modifiable risk factor	Pathophysiological mechanism
Central nervous system	Delirium	Hypernatremia	Excessive sodium load Kidneys inability to excrete excess sodium load
Renal/metabolic	Worse recovery of renal function	Cumulative fluid balance/higher CVP	Renal edema, reduced perfusion pressure
	Worsening acute kidney injury	Unbalanced solutions	Chloride-induced renal vasoconstriction
	Worsening acidemia	Unbalanced solutions	Solution SID relative to plasma SID Kidneys inability to excrete excess chloride load
Respiratory	Impaired gas exchange Altered pulmonar and chest wall mechanics Increased work of breathing	Cumulative fluid balance/higher CVP/higher EVLW	Lung edema
Gastrointestinal	Ileum	Cumulative fluid balance	Bowel edema
	Hepatic congestion	Higher CVP	Hepatic congestion
	Increased intra-abdominal pressure (may induce by itself more organ dysfunctions)	Cumulative fluid balance	Visceral edema (bowel, renal, etc.), ascites
Hemostasis	Increased bleeding	Unbalanced solutions	Acidemia secondary to chloride load
Wound healing	Impaired wound healing	Cumulative fluid balance	Local edema
Hemodynamics	Worse microcirculatory blood flow	Higher CVP	Reduced perfusion pressure

CVP: Central venous pressure; SID: Strong ion difference; EVLW: Extravascular lung water.