The Curbsiders Internal Medicine Podcast

#143 NephMadness: Fluid Wars

March 15, 2019
51 min

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.

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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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