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Balanced Crystalloids or Normal Saline? A Historical and Evidence-Based Perspective.
Trey Richardson1, Nicole Wyatt2, Jasiu Latocha1
1Division of Nephrology and Hypertension, Vanderbilt Integrated Program for Acute Kidney Injury Research (VIP-AKI), Vanderbilt University Medical Center, Nashville, TN, USA.
Journal of Intensive Care Medicine
|November 11, 2025
Summary
Balanced crystalloids and normal saline have different physiological effects. This review examines evidence from pre-clinical, experimental, observational, and clinical studies to guide the optimal use of intravenous crystalloid solutions for volume resuscitation.
Area of Science:
- Critical Care Medicine
- Nephrology
- Fluid Physiology
Background:
- Intravenous crystalloid solutions are standard for volume resuscitation.
- Debate persists regarding optimal crystalloid composition and patient outcomes.
- Balanced crystalloids are increasingly used over normal saline.
Purpose of the Study:
- To review evidence comparing balanced crystalloids and normal saline.
- To explore physiological differences and clinical outcomes.
- To provide guidance for current fluid resuscitation therapy.
Main Methods:
- Review of pre-clinical studies on physiological differences.
- Analysis of experimental human studies.
- Examination of observational studies.
- Synthesis of data from clinical trials.
Main Results:
- Pre-clinical studies identified distinct physiological effects of balanced crystalloids vs. normal saline.
- Human studies confirmed these physiological differences.
- Observational data raised concerns about normal saline use.
- Clinical trials provide evidence for guiding therapy.
Conclusions:
- Evidence supports differential effects of crystalloid solutions on patient outcomes.
- Understanding these differences is crucial for optimal fluid resuscitation.
- Clinical trial data are essential for evidence-based practice in fluid therapy.
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