This podcast explores the crystalloid vs colloid debate and introduces a new paradigm for using large volume resuscitations to treat acid-base disturbances. It discusses the rationale behind switching from normal saline to balanced crystalloids, explores the composition of commonly used crystalloids, and highlights the concept of pH guided resuscitation. Additionally, it delves into the uses, misconceptions, and considerations of bicarbonate therapy in treating acid-base disorders.
Choosing the right fluid for resuscitation is crucial, as it can have a significant impact on patient outcomes.
Isotonic bicarbonate can be used to alkalize patients with non-anion gap metabolic acidosis or uremic acidosis.
Deep dives
Importance of Fluid Selection and pH-Guided Resuscitation
In this podcast episode, the importance of fluid selection and pH-guided resuscitation is discussed. Choosing the right fluid for resuscitation is crucial, as different fluids can have varying effects on patients. The speaker emphasizes that the choice of fluid can have a significant impact on patient outcomes. The use of balanced crystalloids like lactated Ringer's or plasma light is recommended in most cases, as they have minimal side effects and cost-effectiveness. The episode also highlights the role of pH-guided resuscitation, where the choice of fluid is guided by the patient's pH status. For patients with non-anion gap metabolic acidosis or uremic acidosis, isotonic bicarbonate can be administered to alkalize the patient. In cases of acute metabolic alkalosis, acidifying fluids like normal saline are recommended. For patients without any specific pH abnormalities, maintenance fluids like balanced crystalloids are suitable to maintain fluid balance. The importance of reassessing electrolytes and volume status in patients is also highlighted to ensure effective resuscitation.
Controversy over Normal Saline Usage
One of the key points discussed in the podcast episode is the controversy surrounding the universal use of normal saline as a fluid choice. The speaker cautions against using normal saline for every patient, highlighting that it can potentially harm certain patient populations. Instead, the use of lactated Ringer's for most patients is recommended, as it is considered a more forgiving fluid with minimal side effects. The episode emphasizes the need to carefully consider the specific fluid requirements of individual patients rather than using a one-size-fits-all approach of normal saline.
The Role of Bicarbonate in pH-Guided Resuscitation
Another important aspect discussed in the podcast episode is the role of bicarbonate in pH-guided resuscitation. The speaker explains that bicarbonate can be used to alkalize patients with non-anion gap metabolic acidosis or uremic acidosis. Isotonic bicarbonate, formulated by adding three amps of sodium bicarbonate to a liter of D5W, is recommended for alkalizing these patients. However, the use of hypertonic bicarbonate ampules is cautioned against, as it does not effectively treat hyperkalemia and can lead to potential errors. The episode emphasizes the need to give isotonic bicarbonate over time and to be cautious of its effects on potassium levels and ionized calcium levels.
The Importance of Assessing pH Balance and Adjusting Fluid Choice
The podcast episode underlines the significance of assessing a patient's pH balance when choosing the appropriate fluid for resuscitation. The speaker suggests considering isotonic bicarbonate for patients who are severely acidotic, particularly those with uremia. This approach can not only help with volume resuscitation but also address specific pH abnormalities. Additionally, the episode highlights the importance of reassessing electrolytes and volume status to ensure the effectiveness of resuscitation. Overall, the episode provides valuable insights into fluid selection and pH-guided resuscitation, raising awareness about the potential benefits and pitfalls associated with different fluid choices.
In this episode, we cover the always vexing crystalloid vs colloid debate. Farkas also brings it to the next level with a new paradigm for using large volume resuscitations to treat your patient's acid-base disturbances. Come take a listen for all things alkalinizing, acidifying and maintaining.
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