Common Bad Effects of Weight Gain--Edited

Self evident is a patient's struggles to survive when 40 pounds of edema loads an ICU patient .  He can't even bend his arms!  A ventilator struggles to push aside edema fluid.

Emergency Room started "normal" saline IV.  A swelled abdomen squeezed kidneys, slowing blood flow--a strong signal to retain salt and water.  Urine output falls.  Speed the IV.  Abdomen grows tighter--speed the IV!  A viscous cycle is started.

Instead raise serum albumin by giving 25%--moves fluids from edema to vessels.  25% moves fluid from where excess intercellular fluid clogs the system instead 25% moves fluid into vessels where fluid is needed.  Important point!  You want proof?  Check urine Na on a random spec from the catheter of an edematous patient--Na almost absent.  Check after 25% albumin. Urine Na will rise.  Higher urine Na is a sign to you that kidneys release Na, and edema, because of better renal blood flow.

Saline caused colostomy complications?

We thought if all went well we would be able to restart her chemotherapy treatments in about three weeks.  Well, sometimes surgical procedures do not work out as planned and
that was the case with X.  The bowel stoma was under a bit of tension
and pulled away from the skin and back into the deeper layer of the
subcutaneous tissue so it made it difficult to apply the bag and prevent leakage.


I read the above and wonder if "Normal" or Ringer's hung as "routine" operative IV collected in the abdomen, pushed the wall out, made tension and etc, etc.  See Brandstrup who controlled complications in colon cases by care with saline.

IV salt loads

That occasional hospitalized patients gain 20 to 40 pounds and cannot get rid  of it, remains a mystery.  A London doctor in 1700 noted sick void 1/11 of the solids that healthy adults do.  Hospital patients get 20 salt tablets in each IV.  Body holds one liter to dilute that salt.

What is low sodium? Another look.

A patient had "low sodium"  He was treated by adding dietary salt--despite Hx of cardiac problems and edema from recent surgery.

Was it really low sodium?  Yes, in salt concentration.  Serum Na was 124.  

Was it really low sodium?  No, in salt content.   Edema had added 14 Kg.  Each Kg held 124 meq or 10 gm.  His salt supply was high by 10X14 gm = 140 gm!  Since the normal salt content is about 140 gm in vascular plus interstitial spaces,  He had doubled his salt content.  Why add salt?

Better give 25% albumin to shift saline from hurtful, squeezing edema.  Albumin pulls edema into vessels where it is needed to improve renal blood flow.  Better blood flow releases salt to the toilet, releases squeeze.  Harvests salt from content to improve concentration.

Edema hinders rehab

A patient complained, post knee replacement, "My leg was so heavy I could not lift it to do rehab."  Abdominal complications resulted in multiple IVs.  Of course of Normal Saline or Ringers!  Yet the source of the edema, 20 salt tablets injected with each IV, was never suspected!

good other source on ARDS

http://pascalesthoughts.blogspot.com/2010/05/journal-club-is-saline-toxic.html         Consult this site for evidence that weight gain is a serious problem.  I am working the site toward simple and safe measures to test for and treat the weight gain in ARDS.