Kelysey, A physiologist's perspective.
If the patient is Type O - Obese then the 30 ml/kg bolus is excessive. And perhaps ideal wt is better, although lean body mass is what is really needed. And you can not measure that in the ED. Type F- Fit 200Kg, NFL linebacker, Navy SEAL, then 30 ml/kg is appropriate. Not necessarily because they have a stronger heart, but because their weight is roughly proportional to their blood volume, cardiac output, etc. Again true lean body mass would work. Since most patients are more type 1, then the tendency would be to fix the formula at Ideal weight. But don't be afraid to treat the large fit person with larger volumes. g From: "Kelsey K. Solano" <[email protected]<mailto:[email protected]>> Date: Wednesday, May 28, 2014 9:04 AM To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[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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