From the Research
In managing ovarian hyperstimulation syndrome (OHSS), intravenous fluids should be administered cautiously, with crystalloids (particularly normal saline) being the preferred initial choice over colloids, as supported by the most recent and highest quality study 1. The goal of fluid management in OHSS is to correct intravascular volume depletion caused by third-spacing while avoiding worsening ascites and pleural effusions.
- For mild to moderate OHSS, oral hydration is typically sufficient, but severe cases require IV fluid resuscitation with normal saline at rates adjusted to maintain adequate urine output (>30 mL/hour) while avoiding fluid overload.
- Albumin (25%, 50-100g) may be considered in severe cases with significant hypoalbuminemia or when crystalloids alone are insufficient, though its routine use is controversial, as noted in 2 and 3. The underlying pathophysiology involves increased vascular permeability due to VEGF and other inflammatory mediators, causing fluid to shift from intravascular to third spaces, resulting in hemoconcentration and potential complications like thromboembolism and renal failure, as discussed in 4 and 5. Careful monitoring of fluid balance, daily weights, abdominal circumference, and electrolytes (especially sodium) is essential, as OHSS patients are prone to hyponatremia, and diuretics should generally be avoided as they can worsen hemoconcentration and thrombosis risk, as highlighted in 1.