Feeling Salty? Normal Saline vs. Balanced Crystalloids & Quadrupling Asthma Medications


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This week on The Rounds Table Kieran Quinn and Paxton Bach take listeners through articles covering new evidence on prescribing fluids to critically and non-critically ill patients as well as new evidence on increasing the dose of inhaled corticosteroids for asthma exacerbations.

IV fluids are a staple of hospital medicine, almost all patients will receive some form while in hospital. Normal saline and balanced crystalloids are often given interchangeably in practice. Paxton takes listeners through twin randomized, open-label crossover trials, examining the use of normal saline compared to more balanced crystalloids on death and persistent renal dysfunction in non-critically and critically ill patients.

Next, Kieran takes listeners out of the ICU and covers an article on temporarily quadrupling inhaled corticosteroid dosage when asthma symptoms begin to worsen in patients with pre-existing asthma. Inhaled glucocorticoids are pivotal in achieving asthma control and stability. However, despite their use, many patients with asthma have ongoing episodic disease exacerbations that adversely affect quality of life, health, and can even lead to death.

Finally, the Good Stuff segment. Paxton covers an article on the effect of obesity on taste. Kieran shares an article on the origins of the phrase “do no harm.”

Like what you hear? Rate us on iTunes! Chat with us on Twitter @roundstable and tweet at Paxton @paxbach and Kieran @kieranlquinn

Thanks to Christopher Guiliano from Wayne State University for this week’s show title!

The Papers

1. SMART: http://www.nejm.org/doi/full/10.1056/NEJMoa1711584

2. SALTED: http://www.nejm.org/doi/full/10.1056/NEJMoa1711586

3. Quadrupling ICS for Asthma: http://www.nejm.org/doi/full/10.1056/NEJMoa1714257

Good Stuff

1. Obesity and Taste: https://www.sciencedaily.com/releases/2018/03/180320141339.htm

2. Do no Harm: https://www.bmj.com/rapid-response/2011/10/29/origin-primum-non-nocere

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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