In sepsis, management of fluid involves administration of?
Question Category:
Correct Answer:
Crystalloids
Description:
Ans is 'b' i.e. Crystalloids * Crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients & have been recommended as a first choice to resuscitate septic shock patientsFluid resuscitation in septic shock* The landmark of septic shock is systemic vasodilation, with different levels of hypovolemia. Fluid administration is the first-line intervention to restore the systemic hemodynamics and increase oxygen delivery to match oxygen demand in septic patients.* Fluid resuscitation is initiated to achieve a CVP of 8 to 12 mmHg* According to the Surviving Sepsis Campaign Guidelines, septic patients presenting tissue hypoperfusion, hypotension or signs of hypovolemia and admitted to the emergency department must receive an initial fluid load with 30mL/kg of body weight of crystalloids.* Crystalloid refers to solutions containing water, inorganic ions and small organic molecules. Crystalloids are composed of glucose or sodium chloride solutions, and can be hypotonic, isotonic or hypertonic* They supply water and electrolytes to maintain osmotic gradient between extravascular and intravascular compartments as they contain fluids and electrolytes that are normally found in the body.* Colloids have larger molecular-weight particles that give them oncotic plasma pressures similar to natural plasma proteins. This theoretically allows for better volume resuscitation by remaining in the intravascular space and supporting circulating volume as compared to crystalloids, which may have extravascular shift causing pulmonary and interstitial edema. However, in patients with increased vascular permeability as seen in sepsis and late hemorrhagic shock, leakage of these larger colloid molecules also exist.* Hypo-oncotic albumin solutions can be used as an alternative for those who need large amounts of fluids during the initial resuscitation phase.* Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality.
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