Suggested New Year's Resolution: more mindful prescribing of IV fluids 🫧
Far too often I see IV fluids thrown around with minimal consideration; meanwhile, we'll deliberate for hours about a dose of lasix 🤦♀️
Here are the 10 most common fluid prescription mistakes I see 🧵
#emimcc
Far too often I see IV fluids thrown around with minimal consideration; meanwhile, we'll deliberate for hours about a dose of lasix 🤦♀️
Here are the 10 most common fluid prescription mistakes I see 🧵
#emimcc
Comments
These are two very distinct indications for IV fluids and should be in separate mental buckets; each with their own considerations.
Be very clear about the reason for which you are prescribing IV fluids 💉
Most patients just don't need maintenance fluids 🤷♀️
Most ward patients are eating/drinking sufficiently; and most ICU patients are getting enough infusions from other sources.
IF you really think your patient deserves maintenance fluids: please 🙏 include a stop date/time in your order.
I find this is especially problematic with EHRs nowadays, where orders can sometimes slip by for days unnoticed.
There have been a plethora of papers looking at this recently.
For small amounts of fluid (<2L), the difference is likely negligible.
However - if you are going to give prolonged IVF - why give your patient a hyperchloremic non-anion gap metabolic acidosis?
There have been many excellent tweetorials over the years about this from people far smarter than I. The blog post below is over 10 years old!!
RL is safe in hyperK; and actually superior to NS.
https://emcrit.org/pulmcrit/myth-busting-lactated-ringers-is-safe-in-hyperkalemia-and-is-superior-to-ns/
This is a common soap box of mine, but I'll say it again for the people in the back: 🎙️
The job of the right heart is to keep Central Venous Pressure LOW.
A normal CVP is a non-elevated one.
This alone is not an indication for IV fluid!!!