Weekly update 08/06

Llewellyn Davies

08 Jun 2025 — 6 min read

Hi everyone, sorry we have been a bit quiet of late!

The newsletter has suffered some technical difficulties of late and in truth also some human difficulties as well. It’s not easy bringing you the most exciting, well written and just spectacular newsletter we know you long for every week!

But without further adeu this week we shall be taking a trip to Bali an island and actual province of Indonesia. Most people and until one goes about actually going to Bali believe it’s a country. Arguably it’s the most famous part of Indonesia known for its beaches, beauty and affordability. The last of those is probably the reason it’s visited by many South Africans and Australians. In fact Australians use it as we would a Durban holday. If you are ethically white - you are an Australian until proven otherwise.

I was lucky enough to visit Bali for two weeks, it was a peaceful yet busy two weeks. The entire island is geared up for tourists, in fact the locals often say without tourism, Bali is nothing. The hustle and bustle of the town called Kuta is very noticeable people there drive little scooters everywhere and taxis move mostly tourists. It’s not uncommon to see an entire family of 5 on a single scooter!

One would presume that the accident rate is high? Well, not even close to that of South Africa. We have an accident rate of around 14000 per year and Bali around 300 per year! So yes even though a whole family is one a bike built to carry a single person, you are more likely to have an accident in SA.

The beauty of Bali cannot be underestimated , every single street, side post and sign as some significance and architectual design. In Bali, you cannot cut down a tree unless its has spiritual clearance. There is belief that spirits exist in these trees of old ancestors. They are a very controlled, very respectful and happy nation. If someone cuts you off in traffic, they don’t swear or speed past, they simply give a brief toot of the horn and smile and wave. As a South African passenger I want to scream!

If you decide to travel to Bali, one must remember the tap water and anything prepared with tap water is strictly off limits. Bali Belly is real and affects 80 percent of people that travel there. I luckily didn’t get it but infection control was strict i.e showering with your mouth closed, No ice in drinks, no fruit prepared and open at buffets etc.

Below are some of the photos I took, I have so much to say about this little island but then I would be keeping you for the next week reading here and I know you have alot to do !

A little story - I was going to catch the ferry back to Bali island and I hear out of nowhere “ Dr Davies” of course I was shocked as no one around me would call me that ? There I see a familiar face Dr Bhabha, all drenched, hair not done really looking like an island girl. This is how we all looked in Bali as it’s almost 40 degrees and extremely humid. She has also gone on holiday to Bali ( this I wasn’t aware of ) but the chances that we took the same ferry time on the same day and Same island was so amazing. It was very nice to see and old friend all the way on the other side of the world !

Catch up day !

Hey guys :) It’s me, Fatima — the MO who’s now at Wits but still seriously misses UP! Just wanted to say a big THANK YOU for the super generous Takealot vouchers you gave me at my farewell. I used them to buy myself the ultimate treat: a Dyson multistyler! My hair has never looked this good — like, ever — and it’s all thanks to you. Honestly, it was the best gift ever and something I wouldn’t have splurged on myself. So every time I dry and style my hair (which is basically a full glam moment but also takes half the time), I think of you all and smile. Miss you tons! And know you all achieving great things 💜🙏

Academic thought for the week !

Prof S gave us a nice little story of the time overuse of the wrong fluid almost had severe and dire consequences ! So lets have a brush up on the fluids we use mostly.

In anaesthesia, various intravenous (IV) fluids are used to maintain hydration, electrolyte balance, and perfusion. These fluids are broadly classified into crystalloids and colloids, each with specific compositions and indications. Here's a summary of the commonly used fluids and their constituents:

Crystalloids

Crystalloids are solutions of minerals or other water-soluble molecules. They are inexpensive, readily available, and used most commonly.

Fluid	Main Constituents (per litre)	Osmolarity	Notes
Normal Saline (0.9% NaCl)	Na⁺ 154 mmol/L, Cl⁻ 154 mmol/L	~308 mOsm/L (isotonic)	Can cause hyperchloraemic metabolic acidosis with large volumes
Hartmann’s Solution (Lactated Ringer’s)	Na⁺ 131, K⁺ 5, Ca²⁺ 2, Cl⁻ 111, Lactate 29 mmol/L	~273 mOsm/L	Lactate metabolised to bicarbonate – buffer effect; closer to plasma composition
Plasma-Lyte 148	Na⁺ 140, K⁺ 5, Mg²⁺ 1.5, Cl⁻ 98, Acetate 27, Gluconate 23 mmol/L	~294 mOsm/L	Balanced solution; metabolically neutral
5% Dextrose	Glucose 50 g (278 mmol)	~278 mOsm/L	No electrolytes; quickly distributes into total body water; not suitable for resuscitation
Dextrose-Saline (e.g., 4% Dextrose + 0.18% NaCl)	Glucose 40 g, Na⁺ 30, Cl⁻ 30 mmol/L	~280 mOsm/L	Used for maintenance; hypotonic after metabolism of glucose

Colloids

Colloids contain larger molecules (e.g., starches, gelatins, or albumin) that remain in the intravascular compartment longer than crystalloids.

Fluid	Main Constituents	Osmolarity	Notes
Gelofusine	Gelatin (4%), Na⁺ 154, Cl⁻ 120 mmol/L	~274 mOsm/L	Risk of anaphylaxis; expands plasma volume
Volulyte / Voluven (HES)	Hydroxyethyl starch 6%, Na⁺ 137, K⁺ 4, Mg²⁺ 1, Cl⁻ 110, Acetate 24	~290 mOsm/L	Risk of renal impairment and coagulopathy
Human Albumin 4% or 5%	Albumin ~40–50 g/L	~300 mOsm/L	Natural colloid; used in hypoalbuminaemia, liver disease, etc.
Albumin 20%	Albumin ~200 g/L	~300 mOsm/L	Hyperoncotic; pulls fluid into intravascular space

Key Clinical Considerations:

Resuscitation: Use isotonic crystalloids (e.g., Hartmann’s, Plasma-Lyte, saline).
Maintenance: Consider dextrose-saline mixtures with appropriate potassium.
Colloids: Use with caution; albumin may be indicated in specific settings (e.g., sepsis, liver failure).
Avoid hypotonic fluids in the perioperative period due to risk of hyponatraemia.

FLUIDS ARE DRUGS SO USE THEM WISELY !