Hi George
Thanks for that: my main feeling is that the ideal fluid
to give in severe sepsis/shock would presumably be plasma,
or the exact consituents of that which leak out of the
capillaries. Clearly this is not going to be possible,
so, whilst it is important to ascertain which fluids are
better (or least futile, dare I suggest it) than others,
what we clearly also need are better adjunctive therapies
for sepsis (ie. alongside antibiotics) to help switch off
the SIRS and capillary leak, rather than just focussing on
which horses are running away. Make any sense?
Two questions from me while we wait for an effective
adjunctive treatment to come out:
i) Are the lactate components of Ringers' or Hartmann's
anything to worry about?
ii) How much Normal Saline can we give before
hyperchloraemic acidosis becomes an issue.
Thanks very much indeed
Tom Morris
Infectious Disease/General Medicine Registrar
Leicester, UK
On Fri, 19 Apr 2013 11:06:45 +0000
"Kramer, George C." <[email protected]> wrote:
A perspective from a not so humble physiologist studying
fluid resuscitation of shock.
Large volumes of Normal Saline can contribute to
hyperchoremic acidosis and renal dysfunction. Normal
saline is not normal.
Lactated Ringers or better Plasmalye are electrolyte
balanced. plasmalyte is isotonic. Normal saline is
hypertonic (maybe ok, except for the chloride), but LR
is hypotonic, can contribute to cerebral edema. In large
volumes.
In small volumes or relatively 'healthy' patients these
differences are not important.
Albumin best available evidence from mortality
outcomes, is Albumin is not better and may be worst.
However, when you need rapid boast to cardiovascular
function it is superior. Many suggest that mortality
outcomes is not the whole story. And the trial data is
muddled. And the meta-analyses are flawed.
The downside of albumin may be that it leaks into
interstitial space some and holds water and long term is
worst. Lung may be particularly concern. This is more
likely when you have permeability leak and you have that
big time with sepsis.
These topics remain controversial by experts in fluid
space and under appreciated and confusing to non experts.
Best email for me is
[email protected]
George C Kramer, PhD
Director, Resuscitation Research Lab
Professor, Dept. of Anesthesiology
301 University Blvd.
UTMB, Galveston, TX 77555-1102
Office (Mary) 409-747-0077
Direct: 409-772-3969
Cell: 409-939-3040
Lab (Muzna) 409-772-6885
Fax: 409-772-8895
UTMB email: [email protected]
http://www.utmb.edu/rrl/
G
From:
"[email protected]<mailto:[email protected]>"
<[email protected]<mailto:[email protected]>>
Date: Wednesday, April 17, 2013 12:39 PM
To:
"[email protected]<mailto:[email protected]>"
<[email protected]<mailto:[email protected]>>,
"[email protected]<mailto:[email protected]>"
<[email protected]<mailto:[email protected]>>
Subject: Re: [Sepsis Groups] NSS vs Albumin
Usually we see NSS in ED and recently the Intensivists
started adding Albumin to continued need for NSS boluses.
From:
[email protected]<mailto:[email protected]>
[mailto:[email protected]] On
Behalf Of Katzaman, Alecia
Sent: Monday, April 15, 2013 3:10 PM
To:
'[email protected]<mailto:'[email protected]>'
Subject: [Sepsis Groups] NSS vs Albumin
What does everyone do in terms of fluid resuscitation
do you give NSS or Albumin? What do you do in the ED? DO
you have a limit of NSS that is given before Albumin is
given, or is provider specific?
Alecia Katzaman, MSN, RN
Emergency Department Quality Improvement Coordinator
[Description: Description: RHLogo_Email]
P.O. Box 16052
Reading, PA 19612-6052
[email protected]<mailto:[email protected]>
www.readinghealth.org<http://www.readinghealth.org/>
PHONE: 484-628-4810
Advancing Health. Transforming Lives.
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