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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, December 29, 2015

Fluidos en Sepsis

emDocs - December 24, 2015 - Authors: Levesque A and Long B
Edited by: Koyfman A & Bright J
..."So, which fluid do you choose for resuscitation of your septic patient? For the majority of critically ill patients, the data seems to indicate that the usage of balanced crystalloids or albumin will be of most benefit; however, albumin is much more costly and may not be as readily available in some locations. NS is not physiologically normal and may cause hyperchloremic metabolic acidosis and increase trends towards renal injury, while plasmalyte and LR are more physiologic. For the first liter or two, NS will likely not harm the patient and provide adequate resuscitation. It is readily available and will adequately resuscitate the patient. After this point, a more physiologic solution is warranted to avoid complications and improve patient outcome. Realize when you are ordering fluids for your critically ill patient, your choice does matter and can affect patient morbidity and mortality
emDocs - December 29, 2015 - Authors: Levesque A and Long B 
Edited by: Koyfman A & Bright J
..."Where does this leave the emergency physician? At the end of the day providing fluid is vital to adequately resuscitating the patient with sepsis. However, treatment with excessive IV fluids has been shown to be harmful. A combination of clinical end points such as mental status, improved vital signs, urine output, distal perfusion (capillary refill), and ultrasound measurement of IVC should all be used to monitor a septic patient after initial fluid bolus and antibiotic administration.Further studies must be completed to establish if any dynamic parameter can be easily and feasibly utilized in the Emergency Department to determine fluid responsiveness and end points for resuscitation."