IV Fluids: All Are Not Created Equal
IV Fluids: All Are Not Created Equal
Operating under the assumption that the chloride composition of IV fluid affects the risk for AKI, the failure to find a difference in mortality is noteworthy. While multiple studies have demonstrated an increased mortality risk associated with AKI, a recent study attempting to truly isolate this risk suggests that AKI is a marker of the severity of critical illness and does not independently contribute additional risk in a mechanistic manner. If these findings hold up, then avoidance of kidney injury would be unlikely to affect mortality to a significant degree.
These findings are exciting. In an era where advancing healthcare technology has driven US healthcare costs to become 17.9% of the gross national product, the savings associated with the use of different IV fluids could be substantial. However, for those of us who have had to tell a critically ill patient or their family that they will need to be dialyzed, such cost savings are dwarfed by the emotional savings that will occur.
I look forward to further evaluation of these results. And finally, I am grateful to my anesthesiologists who may not have diagnosed me as being lactate deplete but who recognized that, whether or not I knew it, I surely didn't want to overdose on chloride.
With that in mind, perhaps the educational campaign for the proper use of IV fluid should now begin with "just say no to chloride" or "these are your kidneys, and these are your kidneys on chloride."
Abstract
Viewpoint
Operating under the assumption that the chloride composition of IV fluid affects the risk for AKI, the failure to find a difference in mortality is noteworthy. While multiple studies have demonstrated an increased mortality risk associated with AKI, a recent study attempting to truly isolate this risk suggests that AKI is a marker of the severity of critical illness and does not independently contribute additional risk in a mechanistic manner. If these findings hold up, then avoidance of kidney injury would be unlikely to affect mortality to a significant degree.
These findings are exciting. In an era where advancing healthcare technology has driven US healthcare costs to become 17.9% of the gross national product, the savings associated with the use of different IV fluids could be substantial. However, for those of us who have had to tell a critically ill patient or their family that they will need to be dialyzed, such cost savings are dwarfed by the emotional savings that will occur.
I look forward to further evaluation of these results. And finally, I am grateful to my anesthesiologists who may not have diagnosed me as being lactate deplete but who recognized that, whether or not I knew it, I surely didn't want to overdose on chloride.
With that in mind, perhaps the educational campaign for the proper use of IV fluid should now begin with "just say no to chloride" or "these are your kidneys, and these are your kidneys on chloride."
Abstract
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