Fluid Therapy
 

The vast majority of trauma patients (with the exception of cirrhotic patients or severe alcoholics) are hyperglycemic and should not be given glucose with the resuscitation fluids.

Re: Fluid Therapy
 

So guys with Cirrhosis tend to be hypoglycemic, how does one ascertain this from someone who is "out of it"? Not sharpshooting, merely interested:

If I help Nancy consume our approx 8000 bottles of red wine, plus her single malt collection, and my Tequila collection, I may very likely fall into that category:;)

Terry

Re: Fluid Therapy
 

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why are they typically hyperglycemic and is the glucose level prognostic or just an interesting fact?

doc t

Re: Re: Fluid Therapy
 

LOL - in a bad mood?

I'm going to say its part of stress hypermetabolism characterized by substantial increases in metabolic rate, oxygen consumption, and production of carbon dioxide and heat. Energy requirements are amplified by 30% to 50%4 to support inflammation, immune function, and tissue repair.

Yes, its prognostic. There are studies that show increased morbity and sepsis associated with hyperglycemia associated with trauma.

How'd I do?

in a good mood actually... got to spend part of the day with my daughters doing important things like going and seeing Dragon Tales (and dragging aprofsold with me)

but back to the question at hand...

you did well...lol... glucose goes up for a multitude of reasons due to the stress response with alot of anti-insulin type of hormones being secreted... epinephrine, glucagon and especially cortisol. All promote gluconeogenesis and overwhelm a system that is already being overwhelmed on too many fronts.

and yes, recent studies are coming out that it is prognostic as is glucose control during hospitalization.

doc t.

Re: Fluid Therapy
 

Who gives glucose with fluid unless the trauma was a direct result of being hypoglycemic?

James D

Re: Re: Fluid Therapy
 

you would be surprised what outside facilities transfer patients on...

doc t.

Re: Re: Re: Fluid Therapy
 

Come on now...

Outside facilities being smaller ER's?

I have yet to find a useful purpose for D5, D5-1/2 NS, D5-LR on a trauma out here in the street or in a Bay for that matter, but then again...

Re: Re: Re: Fluid Therapy
 

No he wouldn't, he's one of them! LOL

Re: Re: Re: Re: Fluid Therapy
 

When you are deep in the woods, out of water, and really thirsty, the D5W tastes better than the NS.

I drank from a bag of RL one time while trotting around the desert looking for a big blue square of cloth I lost when I pulled a little red thingy on my parachute.

It tasted pretty bad. Of course no telling how long it had been laying out there.

Re: Re: Re: Re: Fluid Therapy
 

Hardy-har-har.

Re: Re: Re: Re: Re: Fluid Therapy
 

Maybe I should have worded that differently and added, "in the prehospital setting."

I can imagine it would be better than NS though.

What degree of blood loss is required to induce hypotension?

Loss of as little as 1/5th of circulating volume can cause Hypovolemia.