Every recommendation that I have seen or heard, most recently from the faculty on the SSC, is to go with actual body weight. Remembering that adipose tissue is highly vascular and contains a large amount of water and that the main 2 reasons for the fluid bolus are 1. Vasodilation reducing perfusion pressure and more importantly 2. Capillary leaking - and with all those miles (literally) of leaky capillaries obese patients have a very high propensity for intravascular volume depletion.
From: Sepsisgroups [mailto:[email protected]] On Behalf Of Kelsey K. Solano Sent: Wednesday, May 28, 2014 7:05 AM To: [email protected] Subject: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg I am wondering whether there are any recommendations regarding fluid resuscitation in patients weighing >200 Kg? Our physicians have expressed concern about the recommended fluid bolus for patients who are > 200 Kg and potential for CHF exacerbations. Are there any resources that address this concern or any modifications for this patient population? Also, is it always recommended to go with 30 ml/kg based on current weight or should we be calculating ideal weight when determining bolus volume? Currently we are using the patient's actual weight on admission for bolus calculations. Any clarifications regarding the fluid bolus would be greatly appreciated. Thanks, Kelsey K. Solano Sepsis Coordinator Email: [email protected]<mailto:[email protected]> Office: 574-335-2438
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