Which medications in the drug class Electrolytes are used in the treatment of Multiple Organ Dysfunction Syndrome in Sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Isotonic crystalloids are the standard for initial volume resuscitation. Fluids are drugs and should be used that way. When given in quantity, they expand the intravascular and interstitial fluid spaces. Typically, approximately 30% of administered isotonic fluid remains intravascular; therefore, large quantities may be required to maintain an adequate circulating volume.

Normal saline and lactated Ringer solution

Both normal saline (NS) and lactated Ringer solution (LR) are essentially isotonic and have equivalent volume restorative properties. Large volume NS resuscitation causes a hyperchloremic metabolic acidosis and in large population-based clinical trials was associated with worse outcomes than patients treated with balanced salt solutions like LR. However, these mortality differences were small. Fluid resuscitation should not be delayed to use a balanced salt solution if NS is the only fluid available.

The amounts of intravascular fluid required are related to the degree of vascular endothelial injury and impaired vasomotor tone; thus, not only may very large quantities of fluids be required initially, but continual fluid resuscitation also is often required during the initial days of management.

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