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Would it be wise for many hospitals to replace saline with balanced fluids for hospitalized patients? It appears so. Doing such a move might significantly reduce mortality and morbidity, according to Vanderbilt University Medical Center's Matthew W. Semler during a presentation at the annual meeting of the Society of Critical Care Medicine.
The study involved 28,000 patients at Vanderbilt University who were given either saline-based IV bags or balanced fluid variants. They found that for every 100 patients on balanced fluids, there was one fewer death or critical kidney damage. Yes, 1 percent doesn't seem a dramatic reduction — but when viewed at a grander scale, that could mean up to 70,000 fewer deaths and 100,000 fewer incidents of kidney problems annually in the United States.
(Score: 5, Informative) by khallow on Wednesday February 28 2018, @09:21PM (12 children)
Saline solution was used in the first place as a fluid replacement because it was balanced in terms of salinity. "Balanced fluids" are merely more balanced in that they preserve the salinity balance with a chemical makeup more like human plasma. Here's the money quote:
(Score: 5, Interesting) by Spook brat on Wednesday February 28 2018, @10:11PM (7 children)
Thanks for pointing out the medpagetoday article; that one from techtimes was awful.
I was surprised that this was an issue at all; the Army had it figured out long ago. Most units have an embedded "Combat Lifesaver", who isn't a medic but carries an aid bag and renders assistance when needed in addition to their normal duties. Combat Lifesavers are issued Lactated Ringer's solution exclusively, not normal saline.
I think there's a bit of institutional inertia going on here; doctors who were trained to use saline because it's compatible with blood transfusions are going to take the position of "no one ever got fired for
buying IBMgiving Normal Saline". Also, anything with sugar in it will change tonicity [yournursingtutor.com] over time as the body uses the sugars for energy, so it's not a fire-and-forget type of solution for replacing fluids.Kudos to the researchers ringing the alarm bell and waking up the doctors who are being lazy with their patients' care.
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(Score: 1) by khallow on Wednesday February 28 2018, @10:52PM (1 child)
(Score: 2) by Spook brat on Thursday March 01 2018, @12:21PM
You were, just not from the one listed as "source" with the big hyperlink at the bottom of the article. I missed the underline on the word "according" in my first skim of the summary, and went for the mor obvious article at the end, with disappointing results.
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(Score: 3, Informative) by frojack on Thursday March 01 2018, @01:02AM
Ringers predates saline in terms of preference. Somewhere the bean counters started practicing medicine.
Another article explains in more detail what constitutes balance: https://www.ncbi.nlm.nih.gov/pubmed/23743589 [nih.gov] and they are not so sure its yet a slam dunk.
No, you are mistaken. I've always had this sig.
(Score: 3, Interesting) by Azuma Hazuki on Thursday March 01 2018, @03:15AM (3 children)
Normal saline sure as hell will get someone fired if they give it in big doses to someone suffering from water toxicity (hyponatraemia). From what I've read, restoring the osmotic balance to "normal" too quickly causes damage to the cells of the brain stem. Scary, and not something I'd *ever* have suspected would happen. I wonder how they found this out...
I am "that girl" your mother warned you about...
(Score: 1) by khallow on Thursday March 01 2018, @04:12AM
The hard way, no doubt. Probably with "Ok, what did this guy die of?"
(Score: 0) by Anonymous Coward on Friday March 02 2018, @02:10AM (1 child)
As someone who was near death due to dehydration and was then quickly hydrated, do you remember where you heard that?
(Score: 2) by Azuma Hazuki on Friday March 02 2018, @03:08AM
This is the opposite problem: water poisoning, resulting in too little (hypo-) sodium (natr-) in the blood (-aemia).
I am "that girl" your mother warned you about...
(Score: 2) by mhajicek on Wednesday February 28 2018, @11:40PM (3 children)
If this study is correct, this change would save twice as many people in the US as are shot to death every year. Why aren't the MSM up in arms over this? This should be on the front page for weeks if lives are what's valued!
The spacelike surfaces of time foliations can have a cusp at the surface of discontinuity. - P. Hajicek
(Score: 2) by insanumingenium on Thursday March 01 2018, @12:07AM
Because no one gets all worked up over pool gates, natural and state disasters are attention grabbing.
(Score: 2) by Runaway1956 on Thursday March 01 2018, @02:50PM (1 child)
So, uhhhh, twice as many people as are shot? Cool - we can quit worrying so much about school shooters?
And, man, don't bother with a serious reply - that's just some smartassery that came to mind. :^)
Abortion is the number one killed of children in the United States.
(Score: 2) by mhajicek on Thursday March 01 2018, @03:17PM
That's kinda my point, and I was applying smartassery myself. :)
The spacelike surfaces of time foliations can have a cusp at the surface of discontinuity. - P. Hajicek
(Score: 3, Informative) by Bill Dimm on Wednesday February 28 2018, @09:31PM (3 children)
From the original article:
Then later:
In the first quote, when he says a "1 percent decrease" does he mean that in an absolute sense (e.g., 3% drops to 2%) or does he mean it in a relative sense (e.g., 3.00% drops to 2.97%)? The second quote seems to imply that he means it in an absolute sense, but then the "1 percent doesn't seem a dramatic reduction" isn't warranted without providing context. Is it dropping from 2% to 1% (very significant) or from 90% to 89%? Yet another journalist that can't write clearly (or doesn't understand the topic about which he is writing).
(Score: 0) by Anonymous Coward on Wednesday February 28 2018, @10:02PM (1 child)
The proper way is with decibels. Well, you could use bels or centibels or millibels.
dB B cB mB
or even microbels
(Score: 2) by insanumingenium on Wednesday February 28 2018, @11:27PM
Even in practices that have adopted logarithmic measurements, things get annoying fast. dBi, dBd, dBm, dBW, dBV, dBv/dBu, dB SPL, dB SIL, ad nauseam are all theoretically they are all dB. Then you can get down to the business of conflating power quantities and root-power quantities and have to explain that all these dBs are not necessarily cross compatible.
(Score: 3, Funny) by The Archon V2.0 on Wednesday February 28 2018, @10:15PM
And this right here is why the financial sector invented basis points, an always-absolute permyriad.
(Score: 0, Disagree) by Anonymous Coward on Wednesday February 28 2018, @10:10PM (3 children)
I'd bet they get an even bigger improvement if they used donated blood.
(Score: 3, Informative) by sjames on Thursday March 01 2018, @01:05AM (2 children)
You would lose that bet. Even with properly cross-matched blood there can be complications. Ringer's and saline are sterile, blood cannot be.
(Score: 2) by dry on Friday March 02 2018, @01:02AM (1 child)
It's also how fast they can get something into someone. Took a friend to emergency yesterday, due to blood lose (varicose veins in his throat let go). It was somewhat busy, and this is Canada with the long waits, so close to 30 minutes before they were putting saline solution in him, whereas they insist on doing blood work before putting blood into him, which was close to another hour.
While blindly putting in O negative might be required occasionally, it seems better to take some more time and make sure the right blood is used.
(Score: 2) by sjames on Friday March 02 2018, @02:06AM
As an American, I assure you that 30 minutes is not a long wait. Unless you come in unconscious or obviously in the process of dying it takes that long to get to the registration desk in order to sign in.
High fever and agonizing pain will sometimes cut a 6 hour wait down to 3.
But yeah, even type O has to be cross matched to avoid the possibility of a minor hemolytic reaction. Even then, there can be adverse effects.
(Score: 2) by JoeMerchant on Wednesday February 28 2018, @10:12PM (2 children)
There's a standard for levels of permissible contaminants in IV fluids, and it's pretty horrid to think about some of the permissible stuff floating around your bloodstream and clogging up capillaries in random, often critical, organs.
I'm willing to believe that "more balanced" fluids can lead to better outcome, but how about "more cleaner" saline as compared to standard medical grade stuff.
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(Score: 1, Touché) by Anonymous Coward on Wednesday February 28 2018, @10:29PM (1 child)
you believe in homeopathy ? cause there is almost as much médecine in an homeopathic dilution that there are contaminants in isotonic saline USP (not more than .05ng per ml)
(Score: 2) by frojack on Thursday March 01 2018, @01:05AM
Are you sure:
http://www.techtimes.com/articles/26935/20150116/fda-begins-investigation-on-contaminated-saline-solutions.htm [techtimes.com]
No, you are mistaken. I've always had this sig.
(Score: 0) by Anonymous Coward on Wednesday February 28 2018, @10:43PM
is it made for 8th graders? something about womens breasts and social media and obvious things like acid eats hard materials and vegetabes were found to be mostly green with natural colors?
(Score: 2) by tangomargarine on Wednesday February 28 2018, @10:45PM (8 children)
I don't suppose there's any chance that this new "balanced fluid" thing costs 3x as much per unit?
"Is that really true?" "I just spent the last hour telling you to think for yourself! Didn't you hear anything I said?"
(Score: 5, Funny) by Immerman on Wednesday February 28 2018, @11:14PM
Of course not.
Nobody would be pushing it if the profit margins were that slim.
(Score: 2) by VLM on Wednesday February 28 2018, @11:54PM (6 children)
I was bored enough to look it up at dixie EMS supply for you.
$4.50 for a liter of saline
$6 for a liter of ringers
You want to see something weird, first of all saline IV requires a prescription but if you can get sterile water, its literally 0.9% salt. You can't use table salt because its got anti-caking stuff added but just think about that, pure saltwater is part of the medical racket. Another oddity is half liter bags are custom and rare so a 500 mL is like twice the price of a 1000 mL, thats the power of logistics, millions of liter bags shipped vs thousands of half liters suddenly twice the stuff costs half the price, in bulk...
Now an ER visit to get a bag of ringers for dehydration will cost four digits at least, and even non ER it would be maybe $100 for the full service labor to hook you up. Its exactly like car repair, its $999 to find the correct bolt or spark plug or connector, while the bolt / plug / connector only costs $1 to replace, thats your $1000 bill. Your ER bill won't go up more than $2 or so per bag, which is kinda a rounding error.
I had considered IV gear when going thru a medic phase. I go hiking in the wilderness, a lot, so I figured it wouldn't be a big deal to get and maintain the training and gear for dehydrated people (myself or family). Uh not so simple, as it turns out. Someday I will do a wilderness-EMT course but thats $500 and fifty hours minimum. Of course that covers a lot of extra stuff thats also a very good idea. Just saying IV is not like CPR where any dude can learn it pretty quick and cheap, its the full WEMT cert (after EMT-Basic) or nothing. Someday, in my infinite spare time...
Dixie is the cheapest place I know of to get non-prescription first aid supplies. While I was still doing cub scouts believe it or not it was cheaper to buy real antibiotic ointment for training first aid than to use ketchup from the food store. Crazy. I have no connection with Dixie other than happy customer etc.
IVs in the context of EMT licenses get doc-droppy because it varies a lot legally by state. Who knows maybe you'd be all good with just EMT-basic depending where you live. Likewise training. Where I live EMT-Basic is community college level and total cost is about $1100 including testing fees and everything. So... to be a good Samaritan out in the woods I'd need to drop like two kilobucks which is either really cheap or really expensive depending on how you look at it. Two kilobucks will buy your family a lot of training, and secondarily, gear, to avoid needing medic support...
(Score: 4, Interesting) by bzipitidoo on Thursday March 01 2018, @05:35AM (1 child)
Don't be too sure that the price of a bag of saline solution includes the labor. But even if it did, it's still outrageously high. It's often over $300. ERs also like to throw in this so called facility fee, which might be to cover labor, but no one can really say for sure. Medical pricing in the US is so messed up and corrupt that no one, not even the health insurers, can explain it.
3 years ago, I went to the ER 3 times, and received a bag of saline solution each visit, for $306 each. Then it got weird. Health insurance reduced the price of the 1st bag to $151, the 2nd bag to $64, and the 3rd bag to $27. WTF?! Shouldn't the same item cost the same each time? Took me a year to learn what I think is the correct reason. Wasted a lot of time arguing with health insurance call center flunkies. About half of them admitted they couldn't explain it. The others pulled explanations out of the air. One thought it was because ER service on the weekend is more expensive. Nope, the $151 was a Thursday, and the $64 was a Saturday. Another thought different drugs must have been added to the saline solution. Nope, nothing was added that way, and if any had been, they would have been separate line items, not bundled into the price of the saline solution. Still another tried to tell me the line items were meaningless and the real prices were set in a secret agreement between the health insurer and the ER that neither I nor he would be allowed to examine. Finally I learned that the prices of the line items are set by the level of ER care (1 through 5) they assign patients. At level 4, the bag is $151, and at level 3 it is $64. So how come the health insurer couldn't tell me that? I also learned from a medical billing advocate that at level 4, the bag is included in the facility fee, so that $151 was them trying to double bill me for that item. As if their rates aren't high enough, they just have to cheat too. Wow. It's obvious the excessive complexity serves to hide crap like that. Anyway, I decided the whole thing was academic, and I told them I did not agree with their pricing schemes, whatever the reasoning was, and refused to pay their prices. I paid them the Medicare rates of about $2 per bag.
By then, they'd long since turned it over to debt collectors. I wasted time trying to explain matters to the debt collectors before I figured out they don't give a crap, they only want the money. Finally told them I would not pay and to never call me again. In hindsight, I should have told them that much sooner. There's not much they can do about it, now that medical debt doesn't much count against your credit rating any more. They could try to sue, but that's very expensive and might backfire on them by exposing their racket, so they won't, not for a few thousand. I really think good citizens need to pressure the medical community much more, by refusing to pay their ridiculous rates, if we are ever to see serious reform in the cost of health care in the US.
Wouldn't surprise me if the price of this new IV liquid is set to at least double what they charge for the saline. Because it's new tech, you know.
(Score: 2) by VLM on Thursday March 01 2018, @09:34PM
I had a girlfriend who had the same experience with a broken arm over about $1000 oh probably a quarter century ago. With medical inflation since then that's probably around $20000 now for the same xray and cast. She claims to have said something like "Well, I don't have any money so you're not getting any money and the debt will fall off my credit report years before I ever get any money or need a loan anyway, so don't bother me anymore" and it worked.
(Score: 0) by Anonymous Coward on Thursday March 01 2018, @07:29AM (2 children)
You were a den mother?
...or things have changed since half a century ago?
...or there is some kink that evaded my remote observations?
-- OriginalOwner_ [soylentnews.org]
(Score: 2) by VLM on Thursday March 01 2018, @09:42PM (1 child)
LOL treasurer and doing first aid training kept them off my back WRT not being an asst scoutmaster or whatever the official title is.
Some of the den mother women were nuts; this is supposed to be for the kids, not a single mother dating program. My wife would come to meeting with me (bodyguard, LOL?) and still the den mothers would flirt with me, which deserves points for effort if nothing else.
Boy scouts gets more political in the sense of small group politics not national politics as discussed here; I can't volunteer as a mentor for the programming merit badge because the scoutmasters little sibling who is also a programmer would treat that as a personal insult, etc etc.
There is very little training at the national level for treasurer past the background check / safety stuff everyone has to take, you pretty much have to learn it yourself which is weird. If you're in direct leadership role or what to get the camping endorsement or whatever theres tons of physical and online classes, but scout treasurers make it up as they go along, unless its very recently changed...
(Score: 0) by Anonymous Coward on Friday March 02 2018, @07:02AM
asst scoutmaster
When I was a kid, that was an Asst. Cubmaster.
Though they've changed some things, I expect it still is.
Boy scouts
That would be where they start calling them Scoutmasters.
the scoutmaster[']s little sibling who is also a programmer would treat that as a personal insult
Life is politics.
You don't have to go far before you trip over that.
-- OriginalOwner_ [soylentnews.org]
(Score: 2) by Magic Oddball on Thursday March 01 2018, @09:14AM
The true oddity is that while a prescription is required to buy Lactated Ringer's or similar fluids, it's not needed in most states to buy the tubing & needles required to inject it.
(Score: 2) by richtopia on Thursday March 01 2018, @12:06AM
Just replace the IV bags with Red Bull.
(Score: 0) by Anonymous Coward on Thursday March 01 2018, @12:15AM
It doesn't have electrolytes, what plants crave.
https://www.youtube.com/watch?v=3boy_tLWeqA [youtube.com]