Fluid Resuscitation in Sepsis with Dr. Srivastava

1. Which fluids should you use?

NS is harmful due to high chloride load. This can lead to vasoconstriction and diminished perfusion of the kidneys.

Use more balanced fluids (LR or normosol)

No role for albumin in fluid resuscitation

When to give NS: patients with hypovolemic hyponatremia, TBI or DKA

When to give LR: all other cases

It is ok to give LR to patients with hyperkalemia as the K concentration is minimal

2. How much and how fast should I give the fluids?

In the acute period, do not be afraid to give fluid (though no reason to be slamming a patient with 15 L in 2 hours)

During their hospitalization, patients with negative/even fluid balance have improved mortality

3. When should you add pressors?

The truth is, no one knows. It seems reasonable to try a quick 20 ml/kg bolus x2 and then add a pressor if the pt is still hypotensive

4. How do we monitor our patient's fluid status?