[Sodium chloride 0.9%: nephrotoxic crystalloid?].

Area of Science:

• Nephrology
• Intensive Care Medicine
• Anesthesiology

Background:

• 0.9% sodium chloride (NaCl) is commonly used but contains higher chloride than plasma.
• Administration of 0.9% NaCl can induce hyperchloremic metabolic acidosis.
• Elevated chloride may adversely affect renal perfusion via renal artery vasoconstriction.

Purpose of the Study:

• To evaluate the clinical consequences of chloride excess from 0.9% NaCl administration.
• To compare 0.9% NaCl with more physiological balanced solutions.
• To investigate the impact on renal perfusion and acid-base balance.

Main Methods:

• Review of prospective, randomized, controlled trials, primarily in perioperative settings.
• Analysis of studies investigating the effects of 0.9% NaCl on acid-base balance and renal hemodynamics.
• Comparison of outcomes between 0.9% NaCl and balanced crystalloid solutions.

Main Results:

• 0.9% NaCl administration reproducibly causes hyperchloremic metabolic acidosis.
• Hyperchloremia is associated with renal artery vasoconstriction, potentially impairing renal perfusion.
• Evidence suggests potential clinical consequences, but further high-quality trials are needed.

Conclusions:

• The high chloride content of 0.9% NaCl may lead to adverse clinical effects.
• Balanced solutions with chloride levels closer to plasma are proposed as a more physiological alternative.
• Further randomized controlled trials are necessary to definitively establish the clinical impact of 0.9% NaCl.