Apr 29, 2015
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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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Think about 2 containers, one holds 1 gallon, one holds 2. The goal is to fill them up. The amount of fluid is important, but the size of the container is just as important.

If you give too much fluid into a full container it's going to end up somewhere you don't want it to go.
 

leviathan

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Although there's a correlation, hypertension does not imply someone is intravascularly full, nor does hypotension imply the opposite. That said, I'm having trouble imagining a scenario where you'd have to fluid 'resuscitate' before arriving to hospital unless the person was hypotensive.