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sábado, 3 de mayo de 2014

Fluídos y PH

PulmCrit: Pulmonary Intensivist's Blog

Friday, May 2, 2014 - Josh Farkas
  1. PART 1: Fluid selection for resuscitation of hypovolemic, hyperkalemic renal failure
  2. PART 2: pH-guided resuscitation
  • Isotonic bicarbonate (D5W with 3 amps bicarb per liter) is a good choice for initial resuscitation of a renal failure patient with acidosis and hyperkalemia, as it may improve both.
  • Normal saline has been proven to worsen hyperkalemia in renal failure and should be avoided in these patients. Contrary to prevailing mythology, LR is safe in hyperkalemic renal failure.
  • The only potential contraindications to LR are elevated intracranial pressure or profound liver failure.4 LR is a reasonable choice of resuscitation fluid for most patients. 
  • Large-volume crystalloid resuscitation represents a unique opportunity to correct certain acid-base disorders using pH-guided resuscitation.
  • Fluids are some of the resuscitationist’s best drugs: correct choice and dosage matter."