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Intravenous fluids: balancing solutions.

Ewout J Hoorn1

  • 1Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Room D-438, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. e.j.hoorn@erasmusmc.nl.

Journal of Nephrology
|December 1, 2016
PubMed
Summary
This summary is machine-generated.

Intravenous (IV) fluid therapy, crucial for fluid balance, is evolving with balanced crystalloids. This review examines IV fluid indications, complications, and the shift from saline to balanced solutions.

Keywords:
Balanced crystalloidsHyperchloremic acidosisHyponatremiaHypotonic fluidsKidney transplantationPediatrics

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Area of Science:

  • Nephrology
  • Intravenous Fluid Therapy
  • Acid-Base Balance

Background:

  • Nephrology traditionally focuses on fluid removal, but fluid, electrolyte, and acid-base balance are central to the specialty.
  • Intravenous (IV) fluid therapy is undergoing significant changes, driven by the increasing adoption of balanced crystalloids and novel IV solutions.

Purpose of the Study:

  • To critically evaluate the current evidence base for IV fluid therapy.
  • To review recent developments, including indications, complications, and characteristics of available IV fluid solutions.
  • To discuss IV fluid use in specific contexts like kidney transplantation and pediatrics, and the implications of saline-induced hyperchloremic acidosis.

Main Methods:

  • Literature review and critical evaluation of existing evidence on IV fluid therapy.
  • Analysis of the characteristics and clinical data of various IV fluid solutions.
  • Examination of specific clinical scenarios and pathophysiological mechanisms.

Main Results:

  • The field is shifting towards balanced crystalloids, partly due to new solution formulations.
  • Saline-induced hyperchloremic acidosis is a recognized complication with potential outcome effects.
  • Evidence supports evaluating a definitive switch from traditional saline to balanced solutions.

Conclusions:

  • IV fluid therapy is an integral part of nephrology, despite its focus on fluid removal.
  • Balanced crystalloids represent a significant advancement, prompting a re-evaluation of standard IV fluid protocols.
  • Further research and clinical practice changes are needed to optimize IV fluid management and mitigate risks associated with traditional solutions.