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Physician, know thy fluids! #FOAMed, #FOAMcc, #FOAMer

How often do we increase the work of breathing by lowering the bicarbonate in expansion acidosis which precipitates a higher Ve..

In patients with a high Vd/Vt this increase can be quite hish.
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thinking critical care

So I posted a quick poll on http://www.therounds.com, a really upcoming physician site, with the intent of getting an idea of what people use as fluids and what they know about them.

The first question was “What is your fluid of choice for resuscitation?”

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…no big surprise, 61% choose NS.  Despite the evidence of increased renal dysfunction (JAMA 2012 – I posted about this here: http://thinkingcriticalcare.com/2013/11/18/enough-with-the-normal-saline-foamed-foamcc/)

Well, at least this is chosen with good knowledge of its pharmacological properties, right?

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Hmmm… 57% peg it as physiological or basic.  Only 9% get it right. The pH is 5.6 or so.

So here we have favorite medication used by a lot of people, who use a lot of it, usually in quite ill patients, often acidotic, and who are not aware that the pH is in fact also quite acidotic.

I think it just is an important example on how we need…

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