Summary: 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.<br> <br> Pearls<br> <br> * 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. <br> * The pH of a IVF does not determine the effect on the patient’s acid-base status. What does?<br> <br> * Strong ion difference<br> * Weak acid content (albumin, phosphate)<br> <br> <br> * The ideal balanced solution has a SID of about 24 (roughly equal to a normal bicarbonate level)<br> * Lactated ringers contains about 130 mEq of sodium, so avoid giving LR to patients with:<br> <br> * Traumatic brain injury<br> * Hyponatremia<br> * Cerebral edema<br> <br> <br> * It is recommended that patients diagnosed with SBP should receive albumin (1.5 g/kg of 25% solution) within 6 hours of diagnosis.<br> <br> <br> Suggested Reading<br> <br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/23817025">Raghunathan K, Shaw AD, Bagshaw SM. Fluids are drugs: type, dose and toxicity. Curr Opin Crit Care. 2013 Aug;19(4):290-8.</a><br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/23743589">Morgan TJ. The ideal crystalloid – what is ‘balanced’? Curr Opin Crit Care. 2013 Aug;19(4):299-307.</a><br> <br> <br>
