Hypertension and Fluid Resuscitation

[Xmus Jaxon Flaxon-Waxon]

Is hypertension a contraindication for fluid resuscitation?

Basic logic would suggest that hypertension is a contraindication to fluid resuscitation b/c extra fluid in the vascular space would increase blood pressure further and put more stress on the heart. I have had a few patients who are febrile with hypertensive blood pressures. It has been told to me that febrile patients require additional fluid. But if the pt's BP is already high should they get fluids?

As I was thinking about this, I thought that a pt could be in state of compensated shock if they had a hypertensive BP but a low blood volume (hypovolemia). In other words, the smooth muscle in the pt's arteries are compressed so much that they reduce the volume of vascular space which increases the BP even though the pt is hypovolemic. So in this example, would fluid resuscitation be beneficial b/c it would help remedy the hypovolemia? I am assuming that the arterial smooth muscle will relax after fluid resuscitation which I'm not sure can be correctly assumed.

So should I be thinking about the volume of blood in a pt rather than the BP when determining whether to use fluid resuscitation or not?

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[link2swim06]

No. Hypertension itself is a pretty useless number in an acute setting.

The one rare exception is hypertensive emergency, where the process causing the hypertension itself is causing end-organ damage. Some of the patients in hypertensive emergency are actually dehydrated and need IV fluids. Other patients in hypertensive emergency (i.e. flash pulmonary edema, missed dialysis) you want to avoid IV fluids.

 

[name?]

Not to be too glib, but pretty much everyone gets better from a little IVF unless they are already volume overloaded to begin with. High BP definitely does not equal volume overload. Even people with flash pulmonary edema are usually euovolemic or hypovolemic which is why lasix isn't the answer, preload/afterload reduction and Bipap cures them. BP often improves with IVF as well. People relax and regress to their mean. If you are going to make someone more hypertensive from fluids, then they have insane vascular tone to begin with and volume is probably still not the issue. Our pipes aren't built like that.

 

[Xmus Jaxon Flaxon-Waxon]

Thanks for your replies! This definitely cleared up a few things!

 

[deleted547339]

It depends.

Diuresis and volume loading primarily influence your venous side. You can be hypertensive from being volume up, but you can also simply have arterial hypertension from peripheral vasoconstriction for a variety of reasons.

Also look at the reason you're giving fluid - don't just give fluid to do something. Positive fluid balance has all sorts of problems down the road.

 

[UKEMdoc]

Hypertension can result from massive vasoconstriction or inappropriate use of vasopressors.

Patient looks rubbish, cold fingers, collapsed veins - they're hypovolaemic. Hypertension means they're in the middle of a chatecolaemic surge. Look at Delerium Tremens for an example.