I wholeheartedly agree. I'm trying to move away as much as I can from NS. Perhaps the nationwide shortage may help in that regard. :)
Hesham A. Hassaballa, MD, FCCP Program Medical Director Critical Care Rush-Copley Medical Center Assistant Professor of Medicine Rush University Medical Center Phone: (331) 454-6572 > On Feb 16, 2014, at 10:47 AM, "Kramer, George C." <[email protected]> wrote: > > Yes, on LR. It does not increase blood lactate, which is not deleterious > in almost all cases anyway. Elevated lactate is 'bad' as it is often an > index of creation of hydrogen ions (acidemia) and inadequate perfusion, > But Lactate is not a harmful solute by itself. > > What I understand is only with liver failure and reduced lactate clearance > does infused LR lead to elevations of lactate. > > High volume of NS cause hypercholremic acidosis. And is associated with > reduce renal perfusion and AKI. > > I would like hearing of a difference of opinion or evidence, from anyone. > > But I believe that the latest word from fluid therapy experts is that > normal saline is not 'Normal' and can be harmful, when infused in excess > of 2 liters, which is not uncommon in sepsis. 30 mL/kg. > > > > On 2/5/14 1:46 PM, "Philip S. Barie" <[email protected]> wrote: > > >LR is not only acceptable, it is preferred by many, especially for > >surgical sepsis. The lactate is equiv to 1/2 amp HCO3/L so it helps > >correct acidosis, which Cl in NaCl may worsen. K of 4.0 not a problem, > >neither is Na 130. > >________________________ ________________ > >From: [email protected] > >[[email protected]] on behalf of Mary Kay Bader > >[[email protected]] > >Sent: Tuesday, February 04, 2014 11:07 AM > >To: Sue Beswick > >Cc: [email protected] > >Subject: [Sepsis Groups] Choice of IV fluids > > > >Greetings all > >With e nation wide shortage of IV Normal Saline....which IV fluids are > >you using. I've heard a few lectures by international and national > >speakers recommending IV lactated ringers (except for renal failure). Is > >anyone using LR? > > > >Mary Kay Bader RN, MSN, CCNS,FAHA, FNCS > >Neuro/Critical Care CNS > >Mission Hospital > >Sent from my iPad > > > >On Feb 4, 2014, at 7:53 AM, "Sue Beswick" <[email protected]> wrote: > > > >> With our severe sepsis flu admits, a number are being admitted without > >>a broad spectrum antibiotics - only getting tamiflu. > >> We aren't using the sepsis database yet but hope to soon - would that > >>be a fail? > >> > >> Thanks > >> Sue > >> > >> Sue Beswick RN, MS, CCNS, CCRN > >> Clinical Nurse Specialist - MSICU > >> Greenville Health System > >> 701 Grove Road l Greenville, SC 29605 > >> Office: 864-455-4884 > >> > >> If not this, then what? If not now, then when? If not me, then who? > >> > >> - John Lewis > >> > >> > >> -----Original Message----- > >> From: [email protected] > >>[mailto:[email protected]] On Behalf Of > >>[email protected] > >> Sent: Friday, January 31, 2014 3:08 PM > >> To: [email protected] > >> Subject: Sepsisgroups Digest, Vol 94, Issue 8 > >> > >> Send Sepsisgroups mailing list submissions to > >> [email protected] > >> > >> To subscribe or unsubscribe via the World Wide Web, visit > >> > >>http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >> > >> or, via email, send a message with subject or body 'help' to > >> [email protected] > >> > >> You can reach the person managing the list at > >> [email protected] > >> > >> When replying, please edit your Subject line so it is more specific > >>than "Re: Contents of Sepsisgroups digest..." > >> > >> > >> Today's Topics: > >> > >> 1. Sepsis tool APACHE question (Dian Nuxoll) > >> 2. severe sepsis screening tool question (Dian Nuxoll) > >> > >> > >> ---------------------------------------------------------------------- > >> > >> Message: 1 > >> Date: Thu, 30 Jan 2014 18:00:54 +0000 > >> From: Dian Nuxoll <[email protected]> > >> To: "'[email protected]'" > >> <[email protected]> > >> Subject: [Sepsis Groups] Sepsis tool APACHE question > >> Message-ID: > >> > >><943B1CFE9FC3DB41AC39532172F66B1B71376B63@EXCHMAIL3.evergreenhealthcare.o > >>rg> > >> > >> Content-Type: text/plain; charset="us-ascii" > >> > >> Under "oxygenation", am I correct to assume this pertains to intubated > >>patients only? > >> > >> Under "FIO2 0.5 or more, A-aDO"-is that the same as A-a Grad? What is > >>this exactly? > >> "< .05, use PAo"-is this the same as PO2?, if not, what is it and how > >>do I find it? > >> > >> Appreciate your help! > >> > >> > >> Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management > >> 425.899.2359 I EvergreenHealth MS-62, 12040 NE 128th St., Kirkland, > >>WA 98034 > >> Follow EvergreenHealth on > >>Facebook<http://www.facebook.com/evergreenhospital.org> and > >>Twitter<http://twitter.com/> | > >>www.evergreenhealthcare.org<http://www.evergreenhealthcare.org/> > >> > >> > >> Please note: My e-mail address has changed to > >>[email protected] > >> > >> > >> DISCLAIMER: > >> EvergreenHealth Confidentiality Notice: This email message, including > >>any attachments, is for the sole use of the intended recipient(s) and > >>may contain confidential and privileged information. Any unauthorized > >>review, use, disclosure or distribution is prohibited. If you are not > >>the intended recipient, please contact the sender by e-mail and destroy > >>all copies of the original message or you may call EvergreenHealth in > >>Kirkland, WA U.S.A at (425)899-1740. > >> -------------- next part -------------- > >> An HTML attachment was scrubbed... > >> URL: > >><http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/at > >>tachments/20140130/5eef97f0/attachment.html> > >> -------------- next part -------------- > >> A non-text attachment was scrubbed... > >> Name: Picture (Device Independent Bitmap) 1.jpg > >> Type: image/jpeg > >> Size: 2471 bytes > >> Desc: Picture (Device Independent Bitmap) 1.jpg > >> URL: > >><http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/at > >>tachments/20140130/5eef97f0/attachment-0001.jpg> > >> > >> ------------------------------ > >> > >> Message: 2 > >> Date: Thu, 30 Jan 2014 23:00:41 +0000 > >> From: Dian Nuxoll <[email protected]> > >> To: "'[email protected]'" > >> <[email protected]> > >> Subject: [Sepsis Groups] severe sepsis screening tool question > >> Message-ID: > >> > >><943B1CFE9FC3DB41AC39532172F66B1B71376CB2@EXCHMAIL3.evergreenhealthcare.o > >>rg> > >> > >> Content-Type: text/plain; charset="us-ascii" > >> > >> Regarding #3. On screen 2: in evaluating the acute lung injury, does > >>the patient have to be intubated for this or just have an ABG? > >> > >> Dian Nuxoll, RN, BSN Clinical Quality Analyst - Quality Management > >> 425.899.2359 I EvergreenHealth MS-62, 12040 NE 128th St., Kirkland, > >>WA 98034 > >> Follow EvergreenHealth on > >>Facebook<http://www.facebook.com/evergreenhospital.org> and > >>Twitter<http://twitter.com/> | > >>www.evergreenhealthcare.org<http://www.evergreenhealthcare.org/> > >> > >> > >> Please note: My e-mail address has changed to > >>[email protected] > >> > >> > >> DISCLAIMER: > >> EvergreenHealth Confidentiality Notice: This email message, including > >>any attachments, is for the sole use of the intended recipient(s) and > >>may contain confidential and privileged information. Any unauthorized > >>review, use, disclosure or distribution is prohibited. If you are not > >>the intended recipient, please contact the sender by e-mail and destroy > >>all copies of the original message or you may call EvergreenHealth in > >>Kirkland, WA U.S.A at (425)899-1740. > >> -------------- next part -------------- > >> An HTML attachment was scrubbed... > >> URL: > >><http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/at > >>tachments/20140130/300630c5/attachment-0001.htm> > >> -------------- next part -------------- > >> A non-text attachment was scrubbed... > >> Name: Picture (Device Independent Bitmap) 1.jpg > >> Type: image/jpeg > >> Size: 2471 bytes > >> Desc: Picture (Device Independent Bitmap) 1.jpg > >> URL: > >><http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/at > >>tachments/20140130/300630c5/attachment-0001.jpg> > >> > >> ------------------------------ > >> > >> _______________________ ________________________ > >> Sepsisgroups mailing list > >> [email protected] > >> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >> > >> > >> End of Sepsisgroups Digest, Vol 94, Issue 8 > >> ******************************************* > >> > >> _______________________ ________________________ > >> Sepsisgroups mailing list > >> [email protected] > >> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > >Notice from St. Joseph Health System: > >Please note that the information contained in this message may be > >privileged and confidential and protected from disclosure. > >________________________ _______________________ > >Sepsisgroups mailing list > >[email protected] > >http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >________________________ _______________________ > >Sepsisgroups mailing list > >[email protected] > >http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > ________________________ _______________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > This message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.
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