There has been a nonstop debate over the use of intravenous fluids, balanced crystalloids versus normal saline, across a wide range of clinical conditions. This time, the discussion has made its way into the management of diabetic ketoacidosis (DKA). What makes this study particularly interesting is that, despite strong opinions on both sides, the results […]
Continue ReadingYesterday, I shared a recent JAMA study examining the use of sodium bicarbonate during cardiac arrest. Today, another important study, this time published in NEJM, explores a different question: should we use sodium bicarbonate in critically ill adults with metabolic acidosis and shock? In this randomized trial, patients with severe metabolic acidosis and shock were […]
Continue ReadingHow much fluid should we give before starting vasopressors in septic shock? Should we continue to administer large fluid boluses, or should we start vasopressors earlier without waiting to see the full response to intravenous fluids? A recent study published in NEJM sought to answer this question by randomizing nearly 1,000 patients with septic shock […]
Continue ReadingIt is fascinating how many studies are often required before we can confidently draw conclusions about a common medical practice. Sodium bicarbonate has historically been one of the most frequently administered medications during cardiac arrest, with prior study reporting its use in approximately 40–50% of cardiac arrest cases. However, a recent publication in JAMA evaluating […]
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