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Medical Category: 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

REBEL Core Cast 16.0 – Decompensated Hypothyroidism

Take Home Points Myxedema coma is severe, decompensated hypothyroidism with a very high mortality. Classic features include: decreased mental status, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia, and hypoventilation Work up includes looking for and treating precipitating causes, most commonly infection as ...

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Endocrine, Metabolic, Fluid, and Electrolytes

The Great Debate Between Balanced and Unbalanced Crystalloids Continues

Background: Although the debate over balanced (i.e. lactated ringers, PlasmaLyte) vs unbalanced (i.e. 0.9% saline) crystalloids has not been settled, fluid resuscitation continues to be a fundamental therapy given to critically ill patients.  0.9% saline is one of the most common ...

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Endocrine, Metabolic, Fluid, and Electrolytes

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