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Wash Away a Bellyache

Arch Surg. 1985;120(9):1088. doi:10.1001/archsurg.1985.01390330094021.
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To the Editor.—I noted a phenomenon that aids in distinguishing between the "surgical abdomen" (eg, appendicitis) and inflammatory diseases that are better treated nonoperatively. Balanced electrolyte (lactated Ringer's) solution is infused rapidly until diuresis heralds rehydration. A minimum of 2 L over 15 to 30 minutes usually is required. The abdominal pain is markedly attenuated in the less seriously ill subjects. Leukocytosis is reduced far out of proportion to the slight hemodilution.

All of the patients under consideration have some degree of dehydration and gastrointestinal tract malfunction. Characteristically, fluid intake is reduced. They also have external losses (fever, vomitus, and/or diarrhea). There is significant internal loss (gut sequestration) of the 7 to 8 L that is secreted daily. For the patient with appendicitis, rehydration does not delay definitive surgery, but aids the subject in coping with subsequent stresses.

A recent patient was considered to be a candidate for immediate


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