Decode Medicine from OPD to ICU rounds
Ringer Lactate (RL) vs Plasma-Lyte Feature Ringer Lactate (RL / Hartmann’s) Plasma-Lyte (Plasma-Lyte A / Plasma-Lyte 148) Type Balanced crystalloid Balanced crystalloid Osmolality ~273–278 mOsm/L (slightly hypotonic) ~294–295 mOsm/L (isotonic) pH ~6.5 ~7.4 Sodium 130 mmol/L 140 mmol/L Chloride 109 mmol/L 98 mmol/L Potassium 4 mmol/L 5 mmol/L Calcium 2.7–3 mmol/L None Magnesium None 1.5 […]
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Dextrose containing fluids Feature D25 (25% Dextrose) ½ DNS (D5 + 0.45% NaCl) DNS (D5 + 0.9% NaCl) Composition 25 g dextrose/100 mL 5% dextrose + 0.45% saline 5% dextrose + 0.9% saline Dextrose 250 g/L 50 g/L 50 g/L Sodium 0 77 mEq/L 154 mEq/L Chloride 0 77 mEq/L 154 mEq/L Osmolarity ~1260–1400 mOsm/L
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Maintenance Fluid in Critical Care (Adult ICU) In modern critical care, maintenance fluid is prescribed far less frequently than in the past because: Early enteral nutrition provides water. Many IV medications already deliver substantial fluid. Excess maintenance fluid contributes significantly to fluid overload, prolonged ventilation, AKI, and mortality. Definition Maintenance fluid replaces Insensible water loss
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Postoperative Fever Postoperative fever is one of the most common complications after surgery, occurring in 20–90% of patients depending on the type of surgery and the definition of fever. Definition Temperature ≥38°C (100.4°F) on two consecutive postoperative days OR single temperature ≥38.5°C (101.3°F) Fever within the first 48 hours is usually due to the inflammatory
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STRESS-RELATED MUCOSAL DISEASE (SRMD) / STRESS ULCERS I. DEFINITIONS 1. Stress-Related Mucosal Disease (SRMD) Acute erosive and ulcerative gastritis occurring in critically ill patients. Includes: Stress erosions (superficial) Stress ulcers (deep, bleeding lesions) 2. Stress Ulcers Multiple shallow mucosal lesions in the gastric fundus and body, caused by hypoperfusion and acid-mediated injury. II. PATHOPHYSIOLOGY 1.
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Splenic Injury (Splenic Trauma) Introduction Splenic injury is the most common solid organ injury following blunt abdominal trauma. The spleen is highly vascular and receives approximately 5% of the cardiac output, making hemorrhage the major cause of morbidity and mortality. Blunt trauma: 80–90% (motor vehicle collisions, falls, sports injuries) Penetrating trauma: Stab wounds, gunshot injuries
Posterior Reversible Encephalopathy Syndrome (PRES) Posterior Reversible Encephalopathy Syndrome (PRES) is a clinicoradiological syndrome characterized by: Acute neurological symptoms Vasogenic cerebral edema (predominantly posterior circulation territory) Reversible changes on neuroimaging It is not always posterior and not always reversible Frontal lobes may be involved Basal ganglia involvement possible Brainstem and cerebellar involvement possible Can even
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Ileus in the ICU Ileus is a functional, non-mechanical inhibition of intestinal propulsion resulting in impaired transit of gas, fluids, and enteral contents through the gastrointestinal tract without an anatomical obstruction. . Pathophysiology ICU ileus is multifactorial. Cause Mechanism Neurogenic mechanisms Critical illness causes ↑ sympathetic activity and ↓ parasympathetic (vagal) activity, resulting in reduced
GASTROPARESIS Delayed gastric emptying in the absence of mechanical gastric outlet obstruction. Epidemiology 40–70% mechanically ventilated patients Up to 60% septic shock patients Common after major surgery More common in: Head injury Stroke Burns Trauma Pancreatitis Multiple organ dysfunction Delayed gastric emptying contributes significantly to Underfeeding Aspiration pneumonia Ventilator-associated pneumonia (VAP) Increased ICU stay Pathophysiology
Nutritional Assessment in ICU A common pitfall in nutritional assessment is misinterpreting the effects of acute illness (e.g., albumin shifts in septic shock) as indicators of underlying malnutrition. History Acute disease effects: Conditions like sepsis, trauma, or inflammation can cause fluid shifts, hypoalbuminemia, and weight fluctuations, which may not reflect true nutritional status. Oral intake
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