When I first discovered I had been cited on a Wikipedia page I was thrilled and honoured. Great to have been noticed. But then the anonymous friend who gave me this fleeting immortality on the Starling equation page gave up and left it in a slightly disorganised and confused state. I have at last caved…… Continue reading The Starling equations, classic and revised, and Wikipedia
Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers N. Van Regenmortel, T. De Weerdt, A. H. Van Craenenbroeck, E. Roelant, W. Verbrugghe, K. Dams, M. L. N.G. Malbrain, T. Van den Wyngaert, P. G. Jorens Br J Anaesth aex118. DOI: https://doi.org/10.1093/bja/aex118 Published:16 May 2017 From the heart of the…… Continue reading Can too much sodium be good for you?
Deservedly getting lots of mentions, Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study Great global collaboration. The stand-out for me is that the UK participating units went from being the world’s worst offenders for colloid resuscitation (>80%) to being second only to Germany as…… Continue reading UK now the world’s 2nd safest place for crystalloid fluid resuscitation!
Fitz-Roy Curry at UC Davis knows more about vascular permeability than I ever will, and I am pleased to say he has offered some thoughts on Paul Marik’s claims for the Norfolk Protocol. With a little text correcting by myself; “Our lab has little experience with Vitamin C and vascular permeability regulation. In some investigations we used…… Continue reading Ascorbic acid; what studies do we need now?
Sartor Z, Kesey J, Dissanaike S. The effects of intravenous vitamin C on point-of-care glucose monitoring. J Burn Care Res. 2015;36:50-56. It seems that we should not rely PoC glucose for patients treated with Vitamin C. Risk for insulin therapy stands out. https://www.ncbi.nlm.nih.gov/pubmed/24502221
While it is easy to make the steady-state Starling case against colloids for resuscitation from hypovolaemia, the argument from microvascular flow preservation keeps alive a possible indication for plasma infusions. The endothelial glycocalyx (EG) disintegrates after severe hemorrhagic shock, and there is laboratory evidence that plasma could preserve or restore capillary integrity. Lyophilised plasma seems to be…… Continue reading Plasma and Vitamin C for shock resuscitation.
I was surprised to learn of the work of Dr Corinne Becker at the Lymphoedema Centre, and with a little searching discovered that many surgeons are now offering autologous lymph node transplant for the treatment of lymphoedema. Students of the steady state Starling principle will understand the rationale; contrary to standard medical school physiology teaching,…… Continue reading Lymph nodes reabsorb lymphatic fluid; a surgical application of an important principle.
Yesterday I did some teaching for NHS HRA Research Ethics Committees in London. I took the opportunity to present the Paul Marik story and covered the pros and cons of offering this treatment “on the NHS” as even-handedly as I could. Then I asked for a show of hands on who would demand a “proper” UK-based…… Continue reading Law (English) and Ethics of withholding Vitamin C for treatment of sepsis.
I was recently amazed to be engaged in a Twitter kerfuffle which generated more than 10,000 Impressions within 24 hours. Passions were running high, libellous comments were being broadcast, and old friendships seemed to be at breaking point. The issue? The ethics of preserving endothelial (im)permeability. This Post reflects my current perspective on things; I…… Continue reading Vitamin C and the ethics of Borrowing data.
Really grateful to the correspondent who pointed me to interesting work being done on “cell impermeants” at Virginia Commonwealth University using the hydrogel PEG-20k. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476060/ http://journals.lww.com/jtrauma/Abstract/publishahead/Low_Volume_Resuscitation_Using_Polyethylene.99474.aspx I was previously unaware of the therapeutic potential for polyethylene glycol and remain uncertain about the “cell impermeant” rationale. Low volume hypertonic and/ or low volume hyperoncotic resuscitation have…… Continue reading Low volume resuscitation – PEGged?