Joe Alcock is joined by evolutionary anthropologist Kate Rusk of Inertia TV and Science Happy Hour to talk about a recent JAMA article studying fluids for adults with sepsis. Do we give too much fluids for these patients? The JAMA article suggests we do. There have been two randomized controlled trials, both performed in Africa, and in both trials more patients died when they received IV fluids. In other words, modern critical care protocols that are standard in US and many European hospitals tend to kill patients in the developing world. What is up with that? We discuss the implications for evolution and critical care in this episode.
Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine
Wonderful teaching aid for a variety of biological disciplines. As you know my area is nutritional biochemistry and immunology and this fits in my world very well. You have a fantastic delivery of your material in a most unassuming way.
My comment on this podcast is that this is the very scenario we observe in groups of farm animals experiencing fever or inflammation-we treat and care for animals in groups as opposed to single organisms as you do-and; I and others have found that cooperating with the animals system(s) is much more effective than using methods that in most cases is not evolutionary cooperative. Reducing fever in nursery pigs appears to increase rate of gain of the survivors but increases overall morbidity and mortality much as you have predicted in some of your previous podcasts. Kurt Klasing a poultry immunologist at UC-Davis has been promoting cooperating with the immune system rather than assaulting it for many years. It is known that many different nutrients and/or combinations of nutrients in the diet that are not observed to be harmful to the animals when they are in a low inflammatory state become harmful in an inflammatory state. Some of the responses depends on whether the infection is intra- or extra-cellular but the observations fit your hypothesis very nicely. Feeding a cold and starving a fever also seems to be evolutionarily sound.
Iron along with other essential transition element are moved from the plasma compartment to other tissues to reduce access by pathogens during inflammation and we have found that feeding extra iron during these periods increases mortality in pigs. Adding hemoglobin to the plasma compartment by blood infusions during an infection seems counterintuitive from an evolutionary standpoint and may contribute to the problems during sepsis.
I really enjoy your podcasts and have learned a new way of thinking because of you and your students.
Thank you Fred for your kind words! My New Year’s resolution this year is to take my teaching, this blog and the podcast to a new level.