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Imagine adding a small amount of sugar to a glass of water, stirring until all the sugar has dissolved, and then adding a bit more. You can repeat this process until the sugar concentration of the solution reaches its natural limit, a limit determined primarily by the relative strengths of the solute-solute, solute-solvent, and solvent-solvent attractive forces. You can be certain that you have reached this limit because, no matter how long you stir the solution, undissolved sugar remains. The...
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Optimization of Crystal Growth for Neutron Macromolecular Crystallography
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What is the ideal crystalloid?

Karthik Raghunathan1, Patrick Nailer, Ryan Konoske

  • 1aDivision of Veterans Affairs bDepartment of Anesthesiology, Duke University Medical Center/Durham VAMC, DUMC, Durham, North Carolina, USA.

Current Opinion in Critical Care
|June 24, 2015
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Summary
This summary is machine-generated.

The ideal intravenous crystalloid solution depends on the patient's clinical context. Balanced electrolyte solutions may improve survival in critically ill patients compared to high-chloride fluids.

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Area of Science:

  • Intravenous fluid therapy
  • Clinical pharmacology
  • Electrolyte balance

Background:

  • Intravenous crystalloids are commonly used in clinical practice.
  • The composition of crystalloid solutions can significantly impact patient outcomes.
  • Understanding fluid distribution and electrolyte effects is crucial for effective therapy.

Purpose of the Study:

  • To review the importance of intravenous crystalloid solution composition.
  • To determine the 'ideal' crystalloid based on clinical context.
  • To provide recommendations for crystalloid use in critical illness, surgery, and specific situations.

Main Methods:

  • Review of current physiologic principles.
  • Synthesis of evidence from basic science and clinical experiments.
  • Analysis of recent observational studies and clinical trials.

Main Results:

  • High-chloride crystalloids (e.g., normal saline) may lead to adverse outcomes in critically ill patients.
  • Balanced crystalloid solutions with physiologic chloride content may enhance survival.
  • Fluid distribution depends on osmolality, glycocalyx integrity, and patient's hemodynamic status.
  • Colloids may offer no additional benefit over crystalloids in critical illness.

Conclusions:

  • Intravenous crystalloids are pharmacologically active agents.
  • Fluid composition, including osmolality, chloride content, and strong ion difference (SID), influences clinical outcomes.
  • The choice of crystalloid should be tailored to the individual patient's clinical context.