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Balanced crystalloids in the acutely ill patient
Samir Samal1, Shakti Bedanta Mishra1, Banani Poddar2
1Department of Critical Care Medicine, IMS and Sum Hospital, Bhubaneswar, Odisha, India.
The National Medical Journal of India
|August 10, 2020
Summary
Normal saline (NS) administration can cause hyperchloremic acidosis and potential renal injury. Balanced salt solutions (BSS) may be a safer alternative, though more research is needed to confirm clinical benefits.
Area of Science:
- Medical Science
- Clinical Research
- Fluid Therapy
Background:
- Intravenous fluid administration is a common hospital therapy.
- Normal saline (NS) use is linked to adverse effects.
- Balanced salt solutions (BSS) offer a buffer and resemble plasma electrolytes.
Purpose of the Study:
- To review studies comparing NS and BSS.
- To identify the effects of NS in various clinical settings.
- To find evidence favoring BSS over NS.
Main Methods:
- Systematic review of studies in ICUs, surgery, renal transplants, and emergency departments.
- Analysis of trials and meta-analyses on NS vs. BSS.
- Evaluation of outcomes including acidosis, renal injury, and mortality.
Main Results:
- NS use strongly associated with hyperchloremic acidosis.
- Higher chloride levels linked to renal injury in ICU patients.
- No significant mortality difference, but higher chloride levels with NS compared to BSS.
Conclusions:
- NS is associated with hyperchloremic acidosis and potential renal injury.
- BSS may offer physiological benefits, but clinical outcomes require further investigation.
- Larger trials with robust methodology are needed to confirm BSS superiority.
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