Management of Acute Abdomen with Severe Dehydration, Acute Kidney Injury, and Metabolic Acidosis

Immediate Resuscitation Priorities

The American College of Surgeons recommends beginning immediate aggressive fluid resuscitation with crystalloid solutions to restore intravascular volume and enhance visceral perfusion 1, 2, 3
The World Journal of Emergency Surgery suggests establishing large-bore intravenous access for rapid fluid administration 3
Administer crystalloid boluses at 20 mL/kg initially if signs of shock are present, as recommended by the Annals of Oncology 4
The fluid volume requirement may be high due to extensive third-space losses from bowel pathology, according to the World Journal of Emergency Surgery 1, 4
Monitor with central venous pressure and urinary catheter to guide resuscitation, targeting urine output >0.5 mL/kg/h, as suggested by the Annals of Oncology 4

Obtain CT angiography of the abdomen immediately to evaluate for acute mesenteric ischemia or bowel perforation, as recommended by the World Journal of Emergency Surgery 2
Serial lactate measurements can assess tissue perfusion and guide resuscitation, according to the World Journal of Emergency Surgery 1, 2, 3
Elevated lactate and D-dimer may assist in diagnosing mesenteric ischemia, as suggested by the World Journal of Emergency Surgery 2

Insert nasogastric tube for decompression to reduce aspiration risk and improve intestinal perfusion, as recommended by the World Journal of Emergency Surgery 1, 2, 3
Administer broad-spectrum antibiotics immediately, according to the World Journal of Emergency Surgery 1, 2, 3

Proceed to prompt laparotomy if signs of peritonitis are present, as recommended by the World Journal of Emergency Surgery 1, 2
Delayed laparotomy increases mortality by 1% every 3 minutes in patients with hemodynamic instability and large peritoneal effusion, according to Anaesthesia 6, 7

Do not delay fluid resuscitation while waiting for laboratory results or imaging, as suggested by Praxis Medical Insights 3
Avoid excessive crystalloid overload which can worsen bowel edema and perfusion, according to the World Journal of Emergency Surgery 1

Consider urgent hemodialysis or continuous renal replacement therapy for severe metabolic acidosis refractory to bicarbonate therapy, as recommended by Praxis Medical Insights 3

Continuous hemodynamic monitoring can guide fluid therapy, according to Praxis Medical Insights 3
Serial arterial blood gases every 2-4 hours initially can monitor acid-base status, as suggested by the World Journal of Emergency Surgery 1, 2
Hourly urine output monitoring can assess renal function, according to the Annals of Oncology and Praxis Medical Insights 3, 4