Dr. Michael Winters returns to discuss IV Fluid resuscitation in the critically ill patient. Should we abandon Normal Saline? What other options are available? What is a balanced fluid, and which patient might benefit from a fluid with a lower SID? Learn the answers, and become an expert in one of the most common therapies given in the ICU by watching this fabulous review by Dr. Winters.
- Myth: It takes approximately 3x as much crystalloid when compared to colloid to achieve the same amount of intravascular volume expansion in IVF resuscitation. Fact: In the critically-ill patient, there is a degradation of endothelial glycocalyx lining the vascular system reducing the ratio to as low as 1.3:1.
- The pH of a IVF does not determine the effect on the patient’s acid-base status. What does?
- Strong ion difference
- Weak acid content (albumin, phosphate)
- The ideal balanced solution has a SID of about 24 (roughly equal to a normal bicarbonate level)
- Lactated ringers contains about 130 mEq of sodium, so avoid giving LR to patients with:
- Traumatic brain injury
- Cerebral edema
- It is recommended that patients diagnosed with SBP should receive albumin (1.5 g/kg of 25% solution) within 6 hours of diagnosis.
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