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[Abnormal saline's swan song].

Paul W G Elbers1,2, Jos Kooter3, Niels van Regenmortel4

  • 1VUmc, afd. Intensive Care Volwassenen, Amsterdam.

Nederlands Tijdschrift Voor Geneeskunde
|July 25, 2018
PubMed
Summary

Balanced solutions are superior to normal saline (NaCl 0.9%) for fluid therapy, reducing hospital mortality and renal failure. Recent trials confirm balanced solutions improve patient outcomes, especially in intensive care and emergency settings.

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Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Emergency Medicine

Background:

  • Administration of normal saline (NaCl 0.9%) can lead to metabolic acidosis and hyperchloremia.
  • Previous retrospective studies linked normal saline use to increased renal failure and mortality.
  • The potential benefits of balanced crystalloid solutions over normal saline in fluid therapy have been debated.

Purpose of the Study:

  • To evaluate the impact of balanced solutions compared to normal saline on patient outcomes.
  • To confirm findings from retrospective studies using large randomized controlled trials.
  • To assess the safety and efficacy of different intravenous fluid therapies.

Main Methods:

  • Two large randomized controlled clinical trials were conducted.

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  • Studies included patients in intensive care and emergency medicine settings.
  • The primary endpoint was MAKE30, a composite of hospital mortality and renal failure indices.

    • Main Results:

    • Balanced solutions significantly reduced the incidence of MAKE30 in both intensive care and emergency medicine patients.
    • Subgroup analysis indicated increased mortality associated with normal saline in intensive care patients with sepsis.
    • While effect sizes were small, the consistency of findings is noteworthy.

    Conclusions:

    • Evidence strongly suggests balanced solutions are preferable to normal saline for intravenous fluid therapy.
    • The findings support a shift away from normal saline, particularly in critical care and sepsis.
    • Normal saline may be gradually phased out of clinical practice due to safety concerns.