The danger of fluid sequestered in the third space is that the fluid:
A. Is hypertonic and can cause hypervolemia.
B. Is hypotonic and can cause water intoxication.
C. Is not available for circulation.
D. Contains large amounts of acids.
Correct Answer: C. Is not available for circulation.
In third-spacing, fluid is sequestered and is unavailable to the general circulation. Third-spacing occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space-the nonfunctional area between cells. This can cause potentially serious problems such as edema, reduced cardiac output, and hypotension.
Option A: Increased fluid volume can be caused by overzealous fluid replacement or renal dysfunction. Volume overload can lead to peripheral edema, pulmonary edema, hepatic dysfunction, cerebral edema and mental changes, and decreased cardiac output. Other signs of fluid overload include jugular vein distension, hypertension, and a pathologic S3.
Option B: Decreased sodium level, or hyponatremia, may result from sodium loss; for example, gastrointestinal losses during diarrhea or fluid losses caused by medications such as diuretics. Hyponatremia can also arise from volume overload. Also called dilutional or hypervolemic hyponatremia, this can occur with overzealous fluid replacement, heart failure, hepatic cirrhosis, renal disease, hypothyroidism, or administration of vasopressin.
Option D: Albumin losses disrupt colloidal osmotic pressure. Plasma proteins are crucial to maintaining colloidal osmotic pressure. Albumin, the major protein constituent of the intravascular space, accounts for up to 60% of total protein. Any condition that destroys tissue or reduces protein intake can lead to protein losses and third-spacing.
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