Mk Normal saline vs. Lactated Ringer’s is a controversial issue in trauma, surgical and medical critical care.
This is my read of the literature. NS and LR were long considered to be equivalent with proponents making a case for LR, but other saying no different. There is a cost difference LR may be $1 or less more a bag. HOWEVER, there is now an extensive and compelling literature that balanced solutions (LR and Plamalyte) are superior to NS. NS is not normal, the boyd does have equal concentrations of Na and Cl. NS can cause renal dysfunction and a hypercholermic acidosis. The acidosis is hard to treat and is not an acidosis like low perfusion acid doses, but has the same impact on enzyme and other functions in the extracellular fluid space. 20% of body wt — (Milieu intérieur) I have seen that medical intensivist still believe little difference and often don’t know the literature. While surgical intensivists and anesthesiologist most often do, or at least I hope. Most Sepsis research focused on colloid vs crystalloid and since most common crystalloid was NS it was believe that was superior. I say Spend the extra dollar. read this recent review, from a surgical intensivist, it covers the topic well. BioMed Research International Volume 2014 (2014), Article ID 984082, 9 pages http://dx.doi.org/10.1155/2014/984082 Review Article Fluid Resuscitation in Sepsis: Reexamining the Paradigm Poorna Madhusudan<http://www.hindawi.com/83284139/>,1,2 Bharath Kumar Tirupakuzhi Vijayaraghavan<http://www.hindawi.com/51918305/>,2,3 andMatthew Edward Cove<http://www.hindawi.com/62643189/>1,2 1Cardiothoracic Intensive Care Unit, NUHS, Singapore 119074 2National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074 3Intensive Care Unit, NUHS, Singapore 119074 Received 25 February 2014; Revised 8 July 2014; Accepted 20 July 2014; Published 11 August 2014 Academic Editor: Baoli Cheng Copyright © 2014 Poorna Madhusudan et al. This is an open access article distributed under the Creative Commons Attribution License<http://creativecommons.org/licenses/by/3.0/>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Sepsis results in widespread inflammatory responses altering homeostasis. Associated circulatory abnormalities (peripheral vasodilation, intravascular volume depletion, increased cellular metabolism, and myocardial depression) lead to an imbalance between oxygen delivery and demand, triggering end organ injury and failure. Fluid resuscitation is a key part of treatment, but there is little agreement on choice, amount, and end points for fluid resuscitation. Over the past few years, the safety of some fluid preparations has been questioned. Our paper highlights current concerns, reviews the science behind current practices, and aims to clarify some of the controversies surrounding fluid resuscitation in sepsis. On Apr 29, 2015, at 10:28 AM, Mary Kay Bader <[email protected]<mailto:[email protected]>> wrote: We used it during the normal saline shortage crisis last year. I heard an interesting presentation at ISICEM in Brussels where they compared NS to LR re sodium content and advocated for its use when you are concerned about sodium. Nothing official on which fluid was better Mk Sent from my iPhone On Apr 29, 2015, at 7:45 AM, mabel bellanca <[email protected]<mailto:[email protected]>> wrote: Hi All, Has anyone hear that lactated ringers solution should be used for fluid resuscitation instead of normal saline? On Monday, April 27, 2015, Gail Taylor <[email protected]<mailto:[email protected]>> wrote: We are currently not using nurse driven protocols except in the ED and with our MRTs. These include lab orders but no fluid or antibiotics. On another subject, has anyone started to address the CMS requirements? 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Re: Nurse Driven Sepsis Protocols (Stephens, Kari) ---------------------------------------------------------------------- Message: 1 Date: Sun, 19 Apr 2015 13:45:56 +0000 From: "Stephens, Kari" <[email protected]<javascript:_e(%7B%7D,'cvml','[email protected]');>> To: "[email protected]<javascript:_e(%7B%7D,'cvml','[email protected]');>" <[email protected]<javascript:_e(%7B%7D,'cvml','[email protected]');>> Cc: "[email protected]<javascript:_e(%7B%7D,'cvml','[email protected]');>" <[email protected]<javascript:_e(%7B%7D,'cvml','[email protected]');>> Subject: Re: [Sepsis Groups] Nurse Driven Sepsis Protocols Message-ID: <[email protected]<javascript:_e(%7B%7D,'cvml','[email protected]');>> Content-Type: text/plain; charset="us-ascii" I would be interested in nurse driven protocols also. Sent from my iPhone On Apr 17, 2015, at 10:25 AM, "[email protected]<mailto:[email protected]><javascript:_e(%7B%7D,'cvml','[email protected]%5Cx3cmailto:[email protected]%5Cx3e');>" <[email protected]<mailto:[email protected]<javascript:_e(%7B%7D,'cvml','[email protected]%5Cx3cmailto:[email protected]');>>> wrote: Good Morning, Our pharmacy department and myself are putting together a presentation on nurse driven protocols and we are needing further resources. We are looking for facilities who have implemented this and have evidence to support that this worked at your facility. Any PowerPoints, research articles or handouts are greatly appreciated! We love anything with stats and data. Even a contact person would be greatly appreciated. Thank you, Katerina Rhynes - RN, BSN Sepsis Coordinator Wesley Medical Center Quality Department 550 N. 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