PulmCrit: Pulmonary Intensivist's Blog
Friday, May 2, 2014 - Josh Farkas
- PART 1: Fluid selection for resuscitation of hypovolemic, hyperkalemic renal failure
- PART 2: pH-guided resuscitation
"Conclusions
- 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."
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