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The case for 0.9% NaCl: is the undefendable, defensible?

Can Ince¹, A B Johan Groeneveld¹

¹Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.

Kidney International

|July 10, 2014

Summary

Normal saline (0.9% NaCl) is the most common resuscitation fluid despite concerns about its acid-base effects. This review defends its use, emphasizing volume and physiological assessment over composition concerns for safe fluid therapy.

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Area of Science:

Critical care medicine
Physiology
Pharmacology

Background:

0.9% NaCl is the most frequently used fluid for resuscitation.
Concerns exist regarding 0.9% NaCl's impact on acid-base homeostasis.
Literature often highlights 0.9% NaCl's adverse effects while neglecting alternatives' risks.

Purpose of the Study:

To defend the use of 0.9% NaCl in fluid resuscitation.
To review the positive attributes of 0.9% NaCl.
To provide context for safe and effective administration of 0.9% NaCl.

Main Methods:

Literature review and critical appraisal.
Discussion of existing evidence on 0.9% NaCl.
Comparative analysis of crystalloid solutions.

Main Results:

0.9% NaCl remains widely used due to various factors, despite documented adverse effects.
Alternative crystalloids also possess potential risks that are often overlooked.
Emphasis on fluid volume and physiological assessment is crucial for effective resuscitation.

Conclusions:

0.9% NaCl can be used safely and effectively when administered in appropriate contexts.
Focusing solely on the composition of resuscitation fluids may be less critical than ensuring adequate volume and monitoring physiological response.
Further research should critically appraise all crystalloid solutions and guide clinical practice based on comprehensive physiological assessment.