Although the obvious effects of overzealous fluid administration include volume overload, pleural effusion, pulmonary edema, and tissue edema, these are not the only components of resuscitation injury.
At the cellular level, cell swelling and dysfunction can occur as sodium and water translocate into the cell.11 Tissue hypoxia also can occur, as oxygen has a greater distance to travel through the interstitial edema in order to reach the cell. Cells begin to function less efficiently, increasing their oxygen demand. Decreased blood viscosity from administration of crystalloids can result in vasoconstriction and reduced tissue perfusion.12
Dilutional coagulopathy (ie, clotting factors diluted by blood loss and administration of coagulation factor-free fluids) has been identified in both humans and animals.13,14 Loss of oncotic pressure, hypoalbuminemia, and tissue edema can lead to impaired healing. Excessive fluid administration has been linked to acute respiratory distress syndrome and multiorgan failure in human patients. Increased bleeding during trauma has been attributed to the effects of both dilutional coagulopathy and increased venous pressure causing premature clot removal.13,14
Together, all of these adverse effects represent what is known as resuscitation injury.
Answer B is incorrect, as acute kidney injury has been associated with infusion of artificial colloids but not with crystalloid solutions.
Answer C is incorrect, as hypoperfusion, lactate accumulation, intracellular acidosis, and cell death are all effects of underresuscitation, which can lead to multiorgan failure, but are not effects from overzealous fluid resuscitation.
Answer D is incorrect, as pleural effusion, pulmonary edema, and peripheral edema are the clinical syndromes that can occur with overzealous fluid administration but do not take into account the molecular and cellular level effects that make up resuscitation injury.