The great fluid debate: saline or so-called "balanced" salt solutions?

Area of Science:

• Pediatric critical care
• Intravenous fluid therapy
• Nephrology

Background:

• 0.9% saline is the most common intravenous fluid in pediatrics.
• Adult studies suggest 0.9% saline is suboptimal for fluid resuscitation.
• Pediatricians should consider the physiopathological implications of 0.9% saline use.

Purpose of the Study:

• To evaluate the potential adverse effects of 0.9% saline in pediatric patients.
• To compare 0.9% saline with balanced salt crystalloids for intravenous fluid therapy.
• To provide recommendations for optimal fluid selection in pediatric care.

Main Methods:

• Review of experimental studies and clinical observations in adults and children.
• Analysis of the physiological effects of 0.9% saline and balanced crystalloids.
• Discussion of clinical relevance and evidence-based recommendations.

Main Results:

• Large volumes of 0.9% saline can lead to hyperchloremic metabolic acidosis, acute kidney injury, and impaired coagulation.
• 0.9% saline may negatively impact vascular function, gastrointestinal perfusion, and increase inflammation.
• Current evidence for clinically significant adverse effects in children remains limited.

Conclusions:

• Intravenous fluid therapy is a critical intervention requiring individualized patient assessment.
• "Balanced" salt crystalloids are generally preferred over 0.9% saline for resuscitation and maintenance in children.
• Further research and development of new pediatric-specific intravenous fluids are needed.