emDocs - June 2, 2016 - Authors: Long A and Long B - Edited by: Koyfman A
"Sepsis can be life-threatening and is a commonly managed condition in the emergency department. This area is heavily researched, with studies evaluating multiple aspects of sepsis including evaluation, management, antibiotic use, intravenous and vasopressor resuscitation, and monitoring. One specific area of research has focused on fluid resuscitation in sepsis, specifically the type and amount of intravenous fluid. With all of the new sepsis updates, what is the literature on the harms of over-resuscitation?
The evidence continues to indicate that over-aggressive fluid resuscitation in septic shock is associated with increased morbidity and mortality. While the Sepsis Campaign Guidelines indicate that a patient with sepsis and hypotension or an elevated lactate (≥4mmol/L) should be treated with a 30ml/kg dose of crystalloid fluids, there is a lack of evidence to support this recommended fluid dose.
In previous discussions, we have addressed that IV fluid choices affect patient outcomes in septic shock, and we have shown the evidence that invasive monitoring coupled with aggressive treatments are actually harming our patients. Please refer to these prior posts for more information:
Summary:
The dosing of intravenous fluids in septic patients should be taken as seriously as any potentially lethal medication. It is essential for physicians to give appropriate doses of intravenous fluids while avoiding fluid overload. Patients’ fluid status must be re-evaluated after administration of fluids. Further research must be conducted to identify the appropriate dosing of intravenous fluid bolus at onset of sepsis and any patient subsets that require different treatment."