An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Albumin is a colloid that is frequently used in the resuscitation of critically ill patients. Amongst those indications we see it used in sepsis and very frequently in the cardiac surgery space. What prompted me to write this post was an article by Joannidis et al. published in Intensive Care Medicine last month. In that …
Continue reading Albumin in Resuscitation: Sepsis, Cardiac Surgery, & Other Indications
To begin, I will disclose my bias. I wanted plasma-lyte to outperform 0.9% NaCl, also called normal saline in critically ill patients. It turns out that after the publication of the PLUS trial, I have to chill the heck out to an extent. On this blog as well as social media, I have scrutinized 0.9% …
Continue reading Plasma-lyte vs. Saline (0.9% NaCl): The PLUS Trial was a Negative Study
A common scenario that occurs daily, heck even perhaps hourly, in most emergency departments or intensive care units around the world including providing patient with IV fluids rapidly to resuscitate hypotensive patients or those who are in shock. In order to mitigate said hypotension/shock, the most common response by clinicians is to administer IV fluids. …
Continue reading Fluid Bolus in Resuscitation: Pressure Bag vs. 999ml/hr on the IV Pump
This page is a work in progress as a IV Fluid guide and will continue to grow throughout the years. Last updated on 3/3/22. This page is quite the mess right now if I am being honest. I will get it together at some point. Just many projects running simultaneously. Table of Contents for the …
Continue reading The IV Fluid Guide: 0.9% NaCl, Ringers Lactate, Plasmalyte & Albumin
The blood pressure is low, give a bolus of fluids. Many times that leads to a "nurse dose" as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or …
Continue reading IV Fluid Overload: Don’t Drown your Patients!
I am not a trauma surgeon. I am not a trauma physician. I do not take care of trauma patients in my current practice. I did several rotations in the trauma intensive care unit during my fellowship training but by know means am I going to pretend to have the knowledge that my colleagues who …
Continue reading Resuscitation of Trauma Patients: 0.9% NaCl (saline) or Plasma-lyte?
It has been 7 years since this study came out, and many since. Here we are still using saline like it's benign. Part of the problem is that clinicians get set in their ways and just don't read. Sorry if that offends anyone, but it's true. Some say, "this has always worked and I haven't …
We all know the order sets for DKA, a bunch of 0.9% NaCl first boluses then drip, insulin drip, replace electrolytes, glucose gets to a certain number, change the fluids to 0.9% NaCl that contains dextrose, wait for the anion gap to close, give long acting insulin, wait a bit, turn off the drip, discharge …
Continue reading Diabetic Ketoacidosis (DKA): Balanced Salt Solutions vs. 0.9% Saline
Here's yet another article discussing Ringer's Lactate versus 0.9% saline solution in renal transplant patients. They also acknowledged the consensus to provide NS rather than LR to avoid hyperkalemia in patients but they weren't happy with that, especially understanding and running into the data suggesting that NS creates the non-anion gap metabolic acidosis from hyperchloremia …
Continue reading Ringers Lactate does NOT increase Potassium more than 0.9% NaCl
People worry about the potassium levels in ringers lactate but what if I were to tell you that there's more hyperkalemia with saline. 0.9% saline is 154mmol/L of sodium and 154mmol/L of chloride. That's it. There's no potassium, calcium, magnesium, nor buffering agent in there. Ringer's lactate, however, has 130mmol/L of sodium, 109mmol/L of chloride, …
Continue reading 0.9% NaCl vs. Ringer’s Lactate: Which Increases Potassium?
