Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered [...]

Background: The integration of Point of Care Ultrasound (POCUS) in hospital medicine, particularly for inferior vena cava (IVC) assessment, promises significant advancements in patient care. This study investigates the efficacy of POCUS with IVC evaluation in guiding fluid management decisions upon admission, a crucial aspect of hospitalist care. Methods: Conducted from January 1, 2021, to [...]

Background: Maintenance intravenous fluids (IVFs) are a critical treatment utilized frequently in pediatric medicine to support children with impaired enteral intake suffering from a wide variety of illnesses. Traditional pediatric practice of utilizing hypotonic fluids is thought to derive from Holiday and Seger’s mathematical calculations on IVFs that concluded that the use of hypotonic fluids [...]

Background: Sepsis is a leading cause of hospital death and readmission (1-2). Prior work has suggested that early, adequate intravenous fluid (IVF) administration during sepsis care is associated with lower mortality, even among those at risk for fluid overload (including patients with chronic kidney disease [CKD] or heart failure [HF]) (3). At the same time, [...]

Background: Acute decompensated heart failure exacerbation is the leading cause of hospitalization in the United States. It was associated with total medical costs of more than $30 billion in 2012 with projections estimating around $70 billion in costs by 2030. Currently, six million people in the U.S. have heart failure, with a little over half [...]

Background: The measurement of fluid balance (FB) for hospitalized patients has been a standard of nursing practice for many years, but its utility and accuracy is questioned in the literature. There is no gold standard benchmark for accuracy of FB measurement. From a clinician’s standpoint, FB data are essential in guiding treatment decisions.  The inaccuracy [...]

Background: Hospitalist have not previously had a primary role in the setting of eating disorders beyond stabilization in an acute care setting. Following stabilization, patients in need of further treatment are transferred to an eating disorder facility. While in inpatient or residential care for their eating disorder, patient are monitored by physicians or mid-level providers. [...]

Background: Continuous intravenous (IV) infusions aimed at avoiding dehydration are often referred to as “maintenance fluids” (MF). These infusions are common in clinical practice. Though guidelines exist for MF use in other countries (NICE 2017), there are no specific guidelines in the US. A shortage of IV fluid has existed since 2013. In 2017, Hurricane [...]

Background: The use of maintenance fluids (MF, continuous intravenous fluid (IVF)) to prevent dehydration is common, yet highly variable in practice. Unnecessary MF can cause patient harm including fluid overload, sleep disruption (associated alarms), and increase falls risks. In 2017, Hurricane Maria destroyed Puerto Rican facilities that were critical in producing IVF, exacerbating an existing [...]

Background: Hospitalized patients are complex and often receive concurrent treatment for multiple diseases. Patients presenting with shortness of breath and infiltrates on chest x-ray may be treated for pneumonia, congestive heart failure (CHF) or both. Fluid and blood pressure management may be particularly challenging for these patients. Our goal was to define the impact of [...]