Balanced crystalloids for septic shock resuscitation

Corrêa, Thiago Domingos; Cavalcanti, Alexandre Biasi; Assunção, Murillo Santucci César de

doi:10.5935/0103-507x.20160079

Cited by 15 publications

(16 citation statements)

References 55 publications

(77 reference statements)

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“…Isotonic fluid solutions (0.9% normal saline, Ringer’s lactate, Hartmann’s solution, Plasmalyte 148 solution) are the preferred maintenance fluids for the ill child ( 38 ). Refer to Table 7 ( 43 ).…”

Section: Maintenance Fluid and Electrolytes Needsmentioning

confidence: 99%

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Anígilájé

2018

Front. Pediatr.

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The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids. In the midst of conflicting literature on fluid and electrolytes therapy, it would appear that isotonic fluids are best suitable for the correction of hypotonic, isonatraemic, and hypernatraemic dehydration. Although oral rehydration therapy is adequate to correct mild to moderate isonatraemic dehydration, parenteral fluid therapy is safer for the child with severe dehydration and those with changes in serum sodium. The article reviews the pathophysiology of water and sodium metabolism and, it uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively). When 3% sodium chloride is unavailable to treat hyponatraemic encephalopathy, 0.9% sodium chloride becomes inevitable, albeit, a closer monitoring of serum sodium is required. The importance of a keen and regular clinical and laboratory monitoring of a child being rehydrated is emphasized. The article would be valuable to clinicians in less-developed countries, who must use pre-mixed fluids, and who often cannot get some suitable rehydrating solutions.

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Section: Maintenance Fluid and Electrolytes Needsmentioning

confidence: 99%

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Anígilájé

2018

Front. Pediatr.

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“… 55 However, there is limited evidence for choice of crystalloids in sepsis and septic shock. 55 , 60 …”

Section: Care Bundlesmentioning

confidence: 99%

Sepsis: The evolution in definition, pathophysiology, and management

2019

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There has been a significant evolution in the definition and management of sepsis over the last three decades. This is driven in part due to the advances made in our understanding of its pathophysiology. There is evidence to show that the manifestations of sepsis can no longer be attributed only to the infectious agent and the immune response it engenders, but also to significant alterations in coagulation, immunosuppression, and organ dysfunction. A revolutionary change in the way we manage sepsis has been the adoption of early goal-directed therapy. This involves the early identification of at-risk patients and prompt treatment with antibiotics, hemodynamic optimization, and appropriate supportive care. This has contributed significantly to the overall improved outcomes with sepsis. Investigation into clinically relevant biomarkers of sepsis are ongoing and have yet to yield effective results. Scoring systems such as the sequential organ failure assessment and Acute Physiology and Chronic Health Evaluation help risk-stratify patients with sepsis. Advances in precision medicine techniques and the development of targeted therapy directed at limiting the excesses of the inflammatory and coagulatory cascades offer potentially viable avenues for future research. This review summarizes the progress made in the diagnosis and management of sepsis over the past two decades and examines promising avenues for future research.

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“…[25][26][27] Las soluciones balanceadas (soluciones cristaloides con menor contenido de cloro) son una opción, aunque no hay trabajos que señalen su superioridad sobre los cristaloides tradicionales. [28][29][30] Los coloides expanden rápidamente el espacio intravascular y permanecen mayor tiempo en él, pero son costosos, provocan alteraciones en la coagulación, disminuyen el calcio iónico con efecto inotrópico negativo, y no hay evidencia que señale su superioridad sobre los cristaloides.…”

Section: Tratamiento (Figura 1)unclassified

Recomendaciones para el manejo del shock séptico en niños durante la primera hora (segunda parte)

2019

Arch Argent Pediat

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Balanced crystalloids for septic shock resuscitation

Cited by 15 publications

References 55 publications

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Sepsis: The evolution in definition, pathophysiology, and management

Recomendaciones para el manejo del shock séptico en niños durante la primera hora (segunda parte)

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