icn victoria - walker on the case against albumin
TRANSCRIPT
- 1. MonashC ritical Care hildrens
- 2. Colloid of the YearvsOverused & Overated
- 3. Posm
- 4. Plasma InterstitialH22O H2ONa+Na+Na+Na+Na+Na+K+Na+Na+ATPExtracellular Fluid Intracellular Fluid
- 5. Plasma InterstitialAlbNa+AlbNa+Na+Na+Na+Na+Na+AlbAlbAlbExtracellular Fluid Intracellular Fluid
- 6. Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 7. Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 8. AAAAAAAPlasma InterstitialExtracellular Fluid Intracellular Fluid
- 9. Plasma InterstitialAAAAAAAExtracellular Fluid Intracellular Fluid
- 10. Plasma InterstitialAAAAAAAExtracellular Fluid Intracellular Fluid
- 11. Plasma InterstitialAAAAAAAExtracellular Fluid Intracellular Fluid
- 12. Na+Na+Na+Na+Na+Na+Na+Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 13. Plasma InterstitialNa+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 14. Plasma InterstitialNa+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 15. F = Kf [( Pvasc Pi ) ( vasc i )]
- 16. F = Kf [( Pvasc Pi ) ( vasc i )]
- 17. F = Kf [( Pvasc Pi ) ( vasc i )]
- 18. F = ( vasc i )
- 19. Posm
- 20. 280mmol/L 3% Saline
- 21. 280mmol/L 3% Saline Osm = 1027-280 = 747mosmol/L = 747 19.32mmHg
- 22. 280mmol/L 3% Saline Osm = 1027-280 = 747mosmol/L = 747 19.32mmHg
- 23. N. SalineN. Saline Osm = 40 67,000 = 0.6mosmol/L = 0.6 19.32mmHg+40gm/l Albumin
- 24. N. SalineN. Saline+40gm/l Albumin
- 25. N. Saline N. Saline+40gm/l Albumin+8gm/l Albumin = 8/67,000 X 19.32= 2.3 mmHg
- 26. N. Saline N. Saline+40gm/l Albumin+8gm/l Albumin2.3 mmHg
- 27. 2.3 mmHg 11 mmHgN. Saline N. Saline+40gm/l Albumin+8gm/l Albumin
- 28. 2.3 mmHg 11 mmHgN. Saline N. Saline+40gm/l Albumin+8gm/l Albumin
- 29. 2.3 mmHg 11 mmHgN. Saline N. Saline+40gm/l Albumin+8gm/l Albumin = 0.8
- 30. 2.3 mmHg 11 mmHgN. Saline N. Saline+40gm/l Albumin+8gm/l Albumin0.8 (11 -2.3)(vasc - i)
- 31. 2.3 mmHg 4.3 mmHgN. Saline N. Saline+15gm/l Albumin+8gm/l Albumin0.8 (4.3 -2.3)(vasc - i)
- 32. 2.3 mmHg 4.3 mmHgN. Saline N. Saline+15gm/l Albumin+8gm/l Albumin0.8 (4.3 -2.3)(vasc - i)
- 33. 2.3 mmHg 4.3mmHg to 5.8mmHgN. Saline N. Saline+15gm/l to 20gm/lAlbumin+8gm/l Albumin0.8 (5.8 -2.3)(vasc - i)
- 34. 2.3 mmHg 4.3mmHg to 5.8mmHgN. Saline N. Saline+15gm/l to 20gm/lAlbumin+8gm/l Albumin=1.2mmHg
- 35. 18mmHg90mmHg10mmHg2mmHg6mmHg
- 36. F = Kf [( Pvasc Pi ) ( vasc i )]
- 37. 35 yo woman on IVF Admitted with OHSS Rx with 5% Albumin Increasing breathlessness ?PE Transported to ICU
- 38. Breathless, sitting uprightHR 120, BP 130/70, CVP 7 Pitting oedema to mid sterumSerum Albumin 30gm/L
- 39. ICU O&GDo Nothing!Diurese More5% Albumin
- 40. Diuresis ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Oedema & breathlessness resolved To ward
- 41. Diuresis ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Oedema & breathlessness resolved To ward
- 42. Diuresis ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Oedema & breathlessness resolved To ward
- 43. Volume Overload140117937047230Pressure mmHgArteriolesCapillariesVenules& VeinsArteries
- 44. F = Kf [( Pvasc Pi ) ( vasc i )]
- 45. Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 46. Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 47. Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 48. Na+Na+Na+Na+Na+Na+Na+Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 49. Na+Na+Na+Na+Na+Na+Na+Plasma InterstitialExtracellular Fluid Intracellular Fluid
- 50. Plasma InterstitialNa+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 51. Plasma InterstitialNa+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 52. Plasma InterstitialNa+Na+Na+Na+Na+Na+Na+PiPiExtracellular Fluid Intracellular Fluid
- 53. Na+Na+Na+Plasma InterstitialNa+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 54. Plasma InterstitialNa+Na+Na+Na+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 55. Plasma InterstitialNa+Na+Na+PiNa+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 56. PlasmaNa+Na+Na+Na+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 57. Na+Na+Na+Na+PlasmaNa+Na+Na+Na+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 58. PlasmaNa+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 59. PlasmaNa+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Na+Extracellular Fluid Intracellular Fluid
- 60. SomethingSomething elseO.R.1.3(0.5, 2.6)2.1(1.0,3.4)1.8(0.9,3.3)2.3(1.9,2.7)2.1(1.8,2.5)2.2(1.9, 2.4)1.0 2.0 3.0ORSmith et al 1991Jones et al 1993Smith et al 1999Ng eta 2004Chu et al 2009
- 61. The only colloidproven to be notworse than saline!
- 62. SAFE Study:Albumin vs Saline: Volume administered3000200010000Albumin SalineDay 1 Day 2 Day 3 Day 41.3 1.6 1.3 1.21.4 1.6 1.3 1.4Mean RatioMean + SD