Ryan King: Using IV fluids to cure a broken heart
The following story was written in December 2021 by Bekah Grimes in ENGL 4824: Science Writing as part of a collaboration between the English department and the Center for Communicating Science.
Have you ever wondered exactly what is inside the common IV you receive when you land yourself in a hospital? It’s supposed to hydrate you, right? Is it a saline mixture? Just what exactly is in that clear liquid?
Dr. David Ryan King focused his Ph.D. research on how IV, or intravenous, fluid treatment can be improved by tailoring it to the needs of specific patients.
King, a recent graduate of the translational biology, medicine, and health doctorate program at Virginia Tech, describes his job as “someone who studies why people get sick and how to keep that from happening.”
Under his mentor, Dr. Steven Poelzing, King studied how heart function can be affected by small changes in blood electrolytes (salts), such as sodium, calcium, and potassium. Through his research, he hopes to discover how electrolyte therapy can be applied in a problem-specific manner so that patients receive the exact treatment they need. Currently, a majority of patients in need of electrolyte therapy receive an “average, one-size-fits -all” IV treatment, he says, and that can cause many problems–-particularly in patients with underlying heart conditions.
King, a first-generation college student who grew up in a lower-income household in Ranlo, North Carolina, comes from a family with a long history of heart disease. During his childhood, his great grandmother suffered from a massive heart attack that almost certainly should have led to her death. King and his family went to the hospital to say their goodbyes, but they weren’t yet needed! With the help of cardiologists, his great grandmother had managed to survive .
This emotional shock stayed with King, inspiring him to learn more about the heart and its problems from an early age. It also provided him a personal motivation for his research: “The older I got,” King says, “the more I realized that I’m probably going to have heart problems, because every other man in my family does.”
Many people tend to think of an IV as the delivery tool to receive a treatment, rather than the IV being the treatment itself. But the use of an IV bag is one of the most common methods of treatment employed by emergency responders and physicians. In fact, inserting an IV is one of the very first things that is done by emergency medical technicians and paramedics in caring for someone who has collapsed from cardiac arrest.
The origins of IV fluid treatment can be traced to 1832, as a novel therapy to treat patients during the 19th century cholera pandemics. At the time, scientists were doing their best to determine how much sodium was in our blood so that they could replace lost fluids.
The sodium level in the most commonly used saline solutions (0.9%) is a bit higher than the sodium levels in humans, says King. This excess sodium load could cause serious complications for patients with pre-existing heart and kidney conditions.
“For the most part, it doesn’t matter,” says King. “If you are pretty healthy, your kidneys will filter out the unneeded sodium. However, if your kidneys aren’t functioning because you just experienced cardiac arrest, you might be flooding the body with more sodium than it can handle.”
Using models designed by King and his collaborators that stopped and restarted blood flow to the heart, the researchers found that high-sodium IV fluids worsened outcomes relative to "normal"-sodium IV fluids. On several occasions, the use of 0.9% sodium IV fluids resulted in the heart simply not starting up again. The results from this study were recently peer-reviewed and published in Scientific Reports.
Thanks to this ongoing research, healthcare professionals may soon be able to reconsider using a one-size-fits-all IV fluid approach and instead create patient-centric treatment plans. King explains, “We found that maybe we shouldn’t put so much sodium in there, maybe other compounds such as calcium, potassium, or magnesium” could be more beneficial than salt. King’s studies allowed him to successfully reformulate and develop an IV fluid that demonstrates improvement in the outcome of cardiac injury, for which he and Poelzing were recently issued a U.S. patent.
“We have this new fluid that is […] currently undergoing late-stage pre-clinical testing with our collaborators,” King clarifies. His team is hopeful that they will be able to get this new treatment to humans in the near future, he says. The use of King’s newly developed IV fluid treatment has the potential to drastically change emergency healthcare and save real people’s lives–-his own, his family members’, and the millions of other individuals that suffer from heart disease-related complications.