#143 NephMadness: Fluid Wars

03.15.2019 - By The Curbsiders Internal Medicine Podcast

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The battle over the superiority of resuscitation fluids is coming to a boil. Enter the Fluid Wars. Are Lactated Ringers superior to normal saline? Will LR increase a patient’s lactate? What about albumin? The Curbsiders quench the thirst for knowledge by turning to masters Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) for guidance in this special @NephMadness episode that will get your feet wet with the complicated world of fluid resuscitation. Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Credits Written and produced by: Justin Berk MD, Pascale Khairallah MD NephMadness Pun Contest produced by: Hannah R Abrams MS3 Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD Time Stamps 00:00 Nephmadness pun contest 02:18 Disclaimer 02:52 Intro to the show and NephMadness, guest bios 08:04 Guest one-liners, 10:58 Joel explains NephMadness 12:58  Guest book recommendations and career advice 17:30 Clinical case; goals of fluid resuscitation; choice of initial IV fluid Corporate (TV series) Comedy Central 19:41 Complications of normal saline 21:29 Colloids versus crystalloids LR versus normal saline is not an innocuous decision 26:32 Saline versus balance fluids. What’s the makeup? 28:19 Does lactated ringers elevate lactate? 31:03 Is hyperkalemia a contraindication for LR? 32:39 Lactated ringers versus plasma-lyte and cost of fluid 34:49 In vitro risks of normal saline 40:31 SMART and SALT-ED trial 46:08 Stuart finds the IV fluid price list 44:37 Each panelist weighs in on saline versus balanced fluids 46:45 Why do patients with metabolic alkalosis thrive on saline? 49:04 Outro

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