Determining Intravascular Volume Status: What Are My Options?

Summary

Evaluating a patient’s intravascular volume status is an essential component of the overall assessment of a patient and is critical to establishing a treatment plan. This is especially true for critically ill patients, septic patients, postoperative patients, and patients with heart failure or kidney disease, to name a few. This webinar will review the methods available for assessing plasma volume status (PVS) and the evidence for their clinical utility.

Learning Objectives

• Discuss the importance of establishing the volume status of patients.
• Review the clinical decision making affected by a patient’s volume status
• Review the concept of “Goal Directed Therapy” in resuscitation and its benefits and pitfalls
• Discuss the implications and adverse outcomes of incorrect assessment of volume status, including acute kidney injury, hypo- and hyper-tension, congestion, etc.
• Evaluate the current methods at our disposal for determining volume status and plasma volume including invasive and non-invasive methods, and the pros and cons of each

Educational Credits

This program offers 1 hour of P.A.C.E. continuing education credits.

This program has been approved by the American Association of Critical Care Nurses (AACN), for 1.00 CERPs, Synergy CERP Category A, File Number 23452. Approval refers to recognition of continuing education only and does not imply AACN approval or endorsement of the content of this educational activity, or the products mentioned.Speakers

Mitchell Rosner, MD, MACP
Henry B. Mulholland Professor of Medicine Chair, Department of Medicine
University of Virgininia Health System

Dennis Begos, MD, FACS, FACRS
Associate Medical Director, Medical and Scientific Affair
Nova Biomedical

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Ionized Magnesium, Not Total, Is A Better Indicator of Hypomagnesemia In Renal Replacement Therapy

Date: Thursday, March 04, 2021
Time: 01:00 PM Eastern Standard Europe 6:00 PM GMT
Duration: 1 hour

Summary
Hypomagnesemia is common in critically ill patients undergoing renal replacement therapy (RRT) and is associated with increased risk of mortality. Measurement of total plasma magnesium (tMg) is the current clinical practice to assess hypomagnesemia in these patients. However, tMg does not accurately represent the level of ionized magnesium (iMg), the physiologically active fraction of magnesium in blood. Multiple reasons that favor iMg and not tMg in assessing RRT-related hypomagnesemia will be discussed.

This webinar will describe an RRT patient population with consistently normal tMg but low iMg. These patients were undergoing continuous venovenous hemofiltration (CVVH) using citrate anticoagulation. In this population, iMg and not tMg was a better discriminating marker for hypomagnesemia and the requirement for magnesium supplementation. The superior detection of hypomagnesemia through iMg testing has particular application to COVID-19 patients since this group often requires a higher citrate concentration during CVVH.

Learning Objectives

• Identify the physiologically active fraction of magnesium in blood
• Review reports of RRT patients with low ionized magnesium but normal total magnesium
• Identify factors that make ionized magnesium a better indicator of hypomagnesemia than total magneisum in RRT

Educational Credits

This program offers 1 hour of P.A.C.E. continuing education credits.

This program has been approved by the American Association of Critical Care Nurses (AACN), for 1.00 CERPs, Synergy CERP Category A, File Number 23499. Approval refers to recognition of continuing education only and does not imply AACN approval or endorsement of the content of this educational activity, or the products mentioned.

Speakers

Wouter Tiel Groenestege, PhD
Clinical Chemist, Central Diagnostic Laboratory
University Medical Center, Utrecht, Netherlands

Dennis Begos, MD, FACS, FACRS
Associate Medical Director, Medical and Scientific Affair
Nova Biomedical

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