An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
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
People worry about the potassium levels in Lactated Ringer's (Ringers Lactate), but what if I told you 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, or buffering agent. Ringer's lactate, however, has 130mmol/L of sodium, 109mmol/L of chloride, 4mmol/L of potassium, …
Continue reading 0.9% NaCl vs. Ringer’s Lactate: Which Increases Potassium?
A little history lesson, my friends, regarding the origins of us calling 0.9% saline solution, aka 0.9% sodium chloride, "normal saline". We are all disappointed in ourselves. You've been calling it normal saline, I've been calling it normal saline, we just can't stop ourselves! Of course you know I am referring to 0.9% sodium chloride …
Continue reading Normal Saline: A History Lesson for the Inappropriate Name
Sometimes we need to make minor adjustments in what we do in the ICU to see a difference. I have been going off for several years now on my instagram account as well as YouTube channel regarding the importance of utilizing balanced crystalloids such as lactated ringers or plasma-lyte and I keep on hearing "there's …
Continue reading Does using Balanced Crystalloids vs. Saline improve mortality in sepsis?