"Fluid Is a Drug"

Nov 02 2012 Published by under Pharmaceuticals

Kidney Week 2012 is in full swing. Earlier I tweeted from a session on acute kidney injury (AKI) in the pediatric population; the Storify of my brief notes follows down below. One quote from Stuart Goldstein of Cincinnati's Center for Acute Care Nephrology hit home with my nephro-tweeps, specifically the title of the post.

Like all drugs, fluids require a physician's order; nurses take off the order; the pharmacy fills the order; and the agent is administered to the patient. Why do we have a rather cavalier attitude to giving intravenous fluids?

He made another point I liked. We should treat kidney replacement therapy in the intensive care unit the way we do ventilators. You do not wait until the patient is pulseless to institute respiratory support; why do we wait until the kidney completely fails before supporting the patient's metabolic needs?

Of interest, his analysis shows that more than 15% volume overload {(liters of intake - output)/baseline weight in kg >0.15} produces higher mortality and longer length of stay. This is also the point where excess volume seems to complicate respiratory support.

The session provided a great review of the history of continuous filtration therapy and information on pediatric AKI (#PAKI) outside of the intensive care unit.

[<a href="http://storify.com/PHLane/pediatric-acute-kidney-injury" target="_blank">View the story "Pediatric Acute Kidney Injury" on Storify</a>]

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