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Monday, February 28, 2022

Potential Harms of IV fluids

emDOCs - February 28, 2022 - By Adam Lalley
Reviewed by: Mark Ramzy; Alex Koyfman; Brit Long
"Conclusion:
Fluid overload has been associated with increased post-operative complications and can be detrimental to multiple organ systems, with consequences including poor gas exchange, impaired renal function and slower wound healing.
Given that no ideal fluid exists, recent literature has suggested that physicians should treat crystalloids like any other prescribed drug. Some suggest that antibiotic selection might serve as a model. This framework involves considering the “4 D’s”:
  • Drug – consider the side effects of fluids (i.e., hyperchloremic metabolic acidosis) along with their benefits; the patient’s underlying conditions (i.e., kidney disease, heart failure, cirrhosis); the specific use of the fluid (i.e., resuscitation, replacement, maintenance); and the type of fluid that would best suit the patient’s needs.
  • Dosing – consider both the timing and the speed of fluid administration relative to the illness course along with the parameters you might use to monitor the patient’s response.
  • Duration – while the triggers to start fluid therapies are often clear, the triggers to stop them are often less evident. Emergency physicians, especially those in critical care, may benefit from establishing clear goals for fluid tapering.
  • De-escalation – the final step is knowing when to withdraw fluids when resuscitation is no longer required.
Hopefully, the framework above along with a review of the handful of conditions mentioned in this article can help emergency physicians to think more deliberately about resuscitative strategies. Sometimes it’s all too easy to check that box for fluids and risk rubbing salt into wounds."