The Curbsiders Internal Medicine Podcast #143 NephMadness: Fluid Wars
Mar 15, 2019
In this engaging discussion, nephrology experts Joel Topf, the Chief of Nephrology at Cashlack Memorial Hospital, and Pascale Khairallah, a second-year fellow at Columbia University, dive into the heated debate of fluid resuscitation. They explore whether Lactated Ringers are superior to normal saline and tackle the effects of these fluids on patient health. Listeners also learn about the fun and educational Neff Madness tournament, which ranks vital nephrology concepts, blending humor with deep insights into modern nephrology practices.
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Goals of Fluid Resuscitation
- Use fluids to restore tissue perfusion and replenish lost bodily fluids.
- Choose fluids thoughtfully based on patient condition and fluid composition.
Us vs. Them Fluid Choices
- Charlie Wray recalls surgeons used lactated ringers and internists normal saline during training.
- He found it confusing and questioned the differing fluid choices between specialties.
Albumin vs Saline Outcomes
- Albumin showed no survival benefit compared to saline in large trials despite higher cost.
- Trauma patients did worse with albumin due to its lower osmolality causing cerebral expansion.
