Septic Kids (And Their Kidneys) Like Balanced Fluids
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The use of balanced crystalloid (PlasmaLyte A) rather than normal saline (0.9% sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock.
Source
Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial. Crit Care Med. 2023 Nov 1;51(11):1449-1460. doi: 10.1097/CCM.0000000000005952. Epub 2023 Jun 9.
ACORN RCT – Piperacillin-Tazobactam or Cefepime?
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In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between the two groups. However, those who received cefepime were more likely to have neurologic side effects.
Source
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583. doi: 10.1001/jama.2023.20583. Online ahead of print.
Is Nirmaltrevir-Ritonavir (Paxlovid) Safe for CKD or Dialysis Patients?
We're trying something new! Watch quick videos, with my personal take on the articles we cover each week and more! Here's the JournalFeed YouTube channel link. ~Clay
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Modified dose nirmaltrevir-ritonavir is well-tolerated in patients with CKD as therapy for mild COVID-19 and effectively suppresses viral load.
Source
Safety Profile and Clinical and Virological Outcomes of Nirmatrelvir-Ritonavir Treatment in Patients With Advanced Chronic Kidney Disease and Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2023 Aug 2:ciad371. doi: 10.1093/cid/ciad371. Epub ahead of print.
DOACS Better than Warfarin in A-fib Even in CKD Patients
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Analysis of multiple prior RCTs finds direct oral anticoagulants (DOAC) have improved safety and efficacy vs. warfarin in atrial fibrillation (AF) even as renal function decreases to as low as 25 mL/min.
Source
Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF. Circulation. 2023 Jun 6;147(23):1748-1757. doi: 10.1161/CIRCULATIONAHA.122.062752. Epub 2023 Apr 12.
Can Clinical or Lab Variables Predict Dehydration Severity in Children with DKA?
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Most pediatric patients with diabetic ketoacidosis (DKA) have mild to moderate dehydration. Clinical and laboratory variables in isolation are not accurate predictors of rehydration needs.
Source
Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis. Ann Emerg Med. 2023 Apr 4;S0196-0644(23)00002-1. doi: 10.1016/j.annemergmed.2023.01.001. Online ahead of print.
Hyperkalemia in a Hemolyzed Pediatric BMP: Repeat or Do Not Repeat?
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There is rarely any need to repeat potassium testing when the laboratory reports hyperkalemia on a hemolyzed sample in a child with a normal blood urea nitrogen (BUN) and creatinine (Cr).
Source
Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat? Pediatr Emerg Care. 2023 Jan 1;39(1):e1-e5. doi: 10.1097/PEC.0000000000002857. Epub 2022 Sep 29.
REFACED RCT – Is Fluid Restriction in Sepsis Feasible?
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IV crystalloid fluid restriction in the first 24-hours for ED sepsis patients without associated shock significantly reduced volumes when compared to standard of care. A larger trial investigating patient-centered outcomes is likely imminent.
Source
Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial. Acad Emerg Med. 2022 Oct;29(10):1172-1184. doi: 10.1111/acem.14546. Epub 2022 Aug 5.
Hypo-K+ Equals Hypo-Mg++…Right??
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This retrospective single-center study found that hypokalemic patients who received magnesium within 4 hours of their potassium supplementation had no significant difference in time to serum potassium normalization.
Source
The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department. J Emerg Med. 2022 Oct 11:S0736-4679(22)00347-X. doi: 10.1016/j.jemermed.2022.06.007. Epub ahead of print.
WATERFALL RCT – Are We Flooding Pancreatitis Patients With Fluid?
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Conservative fluid administration in patients with acute pancreatitis can achieve similar clinical outcomes compared with aggressive resuscitation, with less risk of volume overload.
Source
Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. doi: 10.1056/NEJMoa2202884.
What’s the Best Maintenance Fluid for Children – D51/2NS or D5NS?
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Hypotonic maintenance IV fluid (MIVF) dropped serum sodium at 24 hours compared with isotonic MIVF in pediatric patients. We should stop using D51/2NS for routine MIVF in children.
Source
0.45% Versus 0.9% Saline in 5% Dextrose as Maintenance Fluids in Children Admitted With Acute Illness: A Randomized Control Trial. Pediatr Emerg Care. 2022 Sep 1;38(9):436-441. doi: 10.1097/PEC.0000000000002621. Epub 2022 Jan 26.