Thread by @WesElyMD

1/🧵Fluids in sepsis: When a patient’s blood pressure is too low and they are in shock, as happens all the time with #COVID19 viral #sepsis, we give fluids. This @bmj_latest figure👇makes a bit of sense of where the fluid goes. Let me unpack a bit more…

bit.ly/3lvrL50

https://twitter.com/Paul_Wischmeyer/status/1420750248771686403

2/ 👇 @bmj_latest
We talk about 2 categories of fluids: Crystalloids & Colloids. For crystalloids think “thin fluid like salt water with sugar.” For colloid think “thick fluid with lots of protein like albumin.” The figure shows that crystalloids leak out of the blood vessels…

3/ while colloid stays in the blood vessels. But there are several other important teaching points beyond what the figure shows.
✅ If a person has a lot of edema, as we see in heart, kidney & liver failure, colloids pull fluid into our vessels & ⬆️ blood volume to end shock…

4/ ✅ since most people do not have all that extra fluid outside vessels, we only use colloid ~5-10% of the time. (btw, blood is colloid).

✅ “Balanced crystalloid“ is the preferred fluid for resuscitation. @toddrice_ICU et al showed this in @NEJM

Rev: bit.ly/2VjO4PQ

5/ ✅ Balanced crystalloids include Lactated Ringer's & Plasma-Lyte. They are increasingly used vs saline. They have sodium, potassium & chloride content closer to that of natural fluid in our bodies &, when given intravenously, have fewer adverse effects than saline. BUT…

6/ ✅ crystalloids and colloids leak out of our blood vessels. The figure above did not show that important fact. Only hours after we infuse these fluids, half to more of crystalloid has leaked out. It takes longer for colloid to leak, but when it does it draws fluid out w/ it!

7/fin
✅Take home: #COVID19 causes shock. #unvaccinated people getting hospitalized these days will be treated w many many liters of both crystalloids and colloid, both will leak out, and massive edema develops that takes weeks/months to recover from. Stay safe. #vaccinate

Clarification: all sepsis pts leak fluid (ie, third space). The only time I use colloid to “draw that leaking fluid back in” is when there’s about 20 to 30 L of extra fluid on board as in overt heart, kidney & liver dz. Use balanced crystalloids 1st!
@laxswamy @nickmmark