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. ________________________________ ----- Email Disclaimer ----- This email and any files transmitted with it are confidential and are intended for the named recipient(s). If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any copying, disclosure, dissemination, distribution or review of it or its contents is prohibited. If you have received this email in error, please notify the sender and immediately delete this email from your system. ---------------------------------------
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