Albumin is the most abundant globular plasma protein, an important transport protein, and the primary determinant of oncotic pressure (the colloid osmotic pressure that opposes hydrostatic pressure in determining transcapillary flow). The colloid versus crystalloid debate is a timeless point of contention in acute care medicine, but the general teaching…
Lactated Ringer’s (LR) is a balanced crystalloid solution created by Dr. Sydney Ringer in the 1880s using ex-vivo frog hearts. It contains sodium, chloride, lactate, potassium, and calcium, yielding an osmolarity of 273 mOsm/L (human plasma is ~ 290 mOsm/L). In the OR and ICU, I preferentially use balanced crystalloids…
Normal saline (NS) is one of the most widely used therapies in medicine. One liter of solution contains 154 mEq of sodium and 154 mEq of chloride with a pH ~ 5.5. The fact that the solution is acidic is actually UNRELATED to how it CAUSES non-anion gap acidosis in…
“Starling forces” describe the movement across capillaries as a balance between hydrostatic and oncotic pressure gradients within the capillary and surrounding interstitium. Filtration across the capillary membrane occurs along its entire length and is based on a net driving pressure gradient.
This topic was actually brought up by a medical student who worked with me last week in the operating room. After seeing a unit of packed red blood cells hanging alongside a liter of normal saline on the IV pole, he asked how anesthesiologists know how much fluid to give…
Peripheral intravenous (IV) access is utilized for volume resuscitation, medication administration, blood product transfusion, nutrition, lab draws, and many other reasons. It’s a skill which anesthesiologists perfect through experience but often poses a challenge to new trainees. Let’s discuss the basic set up and some tips.
