Renal

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.

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.

More Acute Kidney Injury With Vancomycin Plus… Pip/Tazo Or Ceftolozane/Tazo?

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Patients receiving vancomycin + piperacillin/tazobactam had greater adjusted odds of acute kidney injury than those receiving vancomycin + ceftolozane/tazobactam.

Source
Nephrotoxicity of Vancomycin in Combination with Beta-lactam Agents: Ceftolozane-tazobactam vs. Piperacillin-tazobactam. Clin Infect Dis. 2022 Aug 19;ciac670. doi: 10.1093/cid/ciac670. Online ahead of print.

Back to BaSICS – First Fluid Choice Matters – A Reanalysis of the BaSICS RCT

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There have been multiple publications since the original SMART and SALT-ED trials, including this Brazilian RCT that initially said fluid choice didn’t matter in critically ill patients. However, a secondary analysis of the BaSICS RCT suggests otherwise.

Source
Association between Type of Fluid Received Prior to Enrollment, Type of Admission, and the Effect of Balanced Crystalloid in Critically Ill Adults. Am J Respir Crit Care Med. 2022;205(12):1419-1428. Doi:10.1164/rccm.202111-2484OC

Recalculating…UTICalc Removes Race as Part of Score

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Race was strongly associated with UTI risk, with non-Black children having 2-4 times greater odds of infection. However, replacement of race with 2 other variable resulted in similar diagnostic accuracy for the UTICalc tool.

Source
Reassessment of the Role of Race in Calculating the Risk for Urinary Tract Infection: A Systematic Review and Meta-analysis. JAMA Pediatr. 2022 Apr 18. doi: 10.1001/jamapediatrics.2022.0700. Online ahead of print.

Do Balanced Fluids Help Critically Ill Children?

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There is some evidence that bolus treatment in critically ill pediatric patients (28 days old to 18 years old) with balanced fluids (such as LR) versus unbalanced fluids (such as NS) results in improved serum bicarbonate and blood pH values. However, it’s not clear if this is clinically beneficial.

Source
Balanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis. Pediatr Crit Care Med. 2022 Mar 1;23(3):181-191. doi: 10.1097/PCC.0000000000002890.

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