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viernes, 1 de julio de 2016

We should engineer a new crystalloid

PulmCrit: - June 29, 2016 - By Josh Farkas 
"Introduction
Considering the importance of crystalloid in critical care, one might expect crystalloid composition to be meticulously engineered and updated. However, our crystalloid choices remain archaic. Normal saline and Lactated Ringers (LR) were developed in the 1800s, whereas Plasmalyte and Normosol emerged in the 1970s.
This post explores how a new crystalloid could be designed, based on modern critical care concepts. The point isn’t necessarily the precise formulation of the proposed crystalloid, but rather that it’s time to consider something new. Continuing to debate the merits of NS vs. LR or Plasmalyte may be repeating the wrong question...
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  • Currently available fluids were all designed before 1980, prior to a modern understanding of electrolyte and lactate metabolism.
  • Saline, LR, and plasmalyte all have some room for improvement.
  • Given that crystalloid is administered to millions of patients, even subtle changes could have an effect on some patients.
  • It might be time to engineer a new crystalloid, designed to combine the strengths of LR and plasmalyte."
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