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Medical Category: Endocrine, Metabolic, Fluid, and Electrolytes

REBEL Core Cast 26.0 – Lactated Ringers

Take Home Points When compared to 0.9% saline, lactated ringers is a more balanced solution and more closely resembles our serum. SALT ED and SMART trials show normal saline may increase the occurrence of major adverse kidney events in comparison …

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Endocrine, Metabolic, Fluid, and ElectrolytesResuscitation

SMART Trial Part 2: Secondary Analysis of Balanced Crystalloids vs Saline in Sepsis

Background: Saline (0.9% sodium chloride) has historically been one of the most common intravenous fluids administered in critically ill adults.  However, the supraphysiologic chloride concentration can cause hyperchloremia, metabolic acidosis, renal vasoconstriction and alter immune function.  There is nothing normal …

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Endocrine, Metabolic, Fluid, and Electrolytes

Does Lactated Ringers (LR) Raise Serum Lactate?

Background: Serial lactate measurements is a common core measure that we follow in septic shock resuscitation. A number of readers have written in enquiring about whether resuscitation with lactated ringers instead of 0.9% saline would lead to increases in serum lactate.   …

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Endocrine, Metabolic, Fluid, and Electrolytes

REBEL Core Cast 18.0 – DKA Tips and Tricks

Take Home Points When looking at pH and bicarb, the differences between VBG and ABG are miniscule. For DKA patients, stick with the VBG as is less painful and has fewer complications.  LR is probably a better fluid for the …

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Endocrine, Metabolic, Fluid, and Electrolytes

Rebellion in EM 2019: What the Fluid? Wieters vs Bryant

Normal saline started being used based on work done in the 1830s with cholera.  We are still doing the same thing the same way and it’s not until recently we have begun to ask the hard questions about why we …

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Endocrine, Metabolic, Fluid, and Electrolytes

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