You must consider the type of fluid you are giving. NS volume of distribution in only extracellular due the cell wall sodium pump. Most fat is intracellular and the saline will not be distributed into the fat cell. That is why we use predicted body weight. I agree with George Kramer the best would be Ideal body weight but that is not practical in the acute resuscitation scenario. When giving free water like D5W then the intracellular distribution needs to be taken into account.
Terry P. Clemmer, MD Director: Critical Care Medicine LDS Hospital Professor of Medicine University of Utah School of Medicine Salt Lake City, Utan 84143 Work Phone: 801-408-3661 Work Fax: 801-408-1668 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Barnes-Daly, Mary Ann Sent: Thursday, May 29, 2014 4:19 PM To: 'Kelsey K. Solano'; '[email protected]' Subject: Re: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg 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]<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
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
