clovers

More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)

Today, we're going to be reviewing what some might consider to be a landmark study: the CLOVERS trial. The first thing most clinicians do when a patient is hypotensive is provide IV fluids. The surviving sepsis guidelines recommend 30cc/kg in patients who are in septic shock. It often bears reminding that the objective of providing …

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lactic acid sepsis

Lactic Acid/Lactate in Sepsis & the Critically Ill: The Ultimate Guide

This post will be a compendium of all things and questions we ask ourselves regarding lactate/lactic acid in sepsis and other critically ill patients. We have become a culture where, as soon as a person hints at being sick, we check a stat lactate/lactic acid. If we understand our enemy, we won't be frightened by …

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Lactic Acid has a WIDE Differential Diagnosis (not just Sepsis)

There's a pendulum in medicine. Some things are over recognized and aggressively treated, some things are under appreciated (like subtle decreases in serum bicarb showing that the patient is becoming more acidotic and no one notices because the patient has obesity hypoventilation syndrome and their baseline bicarb is 34 and now has a bicarb of …

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Lactic Acid is an Alarm, not a Treatment in Sepsis and Septic Shock

I need to eat my words on this one, because now there's data to show that there's a benefit to rechecking lactate levels in septic patients, but not for the reasons why one would think. During my rounds over the course of the weekend, I recall telling several nurses that there's no data to suggest …

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Lactic Acidosis: Does it really mean Hypoperfusion?

Having an elevated lactate in septic acid on admission is bad. Trending it, as studies that I have shown on this page does not change mortality. Seeing the numbers downtrend do give us that warm and fuzzy feeling inside, though. We give off a sigh of relief when that number becomes "euboxic". This article was …

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