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Volumensubstitution mit NaCl 0,9 %

Segen oder Fluch?

NaCl 0.9 % for volume substitution

Blessing or curse?

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Zusammenfassung

Der unphysiologisch hohe Chloridgehalt von 0,9 %iger NaCl-Lösung induziert eine hyperchlorämische Azidose und vermindert akut die Nierendurchblutung gesunder Probanden – negative Effekte die unter balancierten Kristalloiden mit niedrigem Chloridgehalt nicht auftreten. Mehrere kürzlich publizierte Studien zeigen sehr eindrücklich, dass NaCl 0,9 % im Vergleich zu balancierten Kristalloiden das Outcome chirurgischer und intensivpflichtiger Patienten signifikant verschlechtert. Im Vordergrund stehen hierbei die höhere postoperative Krankenhaussterblichkeit wie auch das häufigere Auftreten einer akuten Nierenschädigung mit Dialysepflichtigkeit. Obwohl NaCl 0,9 % als Goldstandard in vielen Leitlinien implementiert ist, existiert nach aktuellem Kenntnisstand keine Indikation zur Verwendung von NaCl 0,9 % anstelle moderner, balancierter Infusionslösungen. Dies gilt auch und insbesondere für Patienten mit Hyperkaliämie und akuter bzw. chronischer Nierenschädigung. Interne Fortbildungsveranstaltungen sind ein effektives Instrument, um pflegerische und ärztliche Mitarbeiter nachhaltig für diese Thematik zu sensibilisieren und alternative Strategien aufzuzeigen.

Abstract

The nonphysiological high chloride content of 0.9 % saline causes hyperchloremic acidosis and rapidly reduces renal perfusion in healthy volunteers—negative affects not seen with balanced crystalloids with low chloride content. Evidence from recently published studies strongly suggests that 0.9 % saline negatively effects outcome in surgical and critically ill patients. Major complications are the increased incidence of acute kidney injury and need for renal replacement therapy, as well as higher postoperative in-hospital mortality. Although implemented as the gold standard in many clinical guidelines, there are currently no data supporting the use of 0.9 % saline instead of modern balanced crystalloids. This is also and even particularly true for patients with hypokalemia and acute or chronic kidney injury. In-house training is an effective tool for sustainably raising the awareness of this issue among nursing and medical staff, and identifying alternative strategies to the use of NaCl 0.9 % in clinical practice.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Kümpers gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Medizinische Klinik D, Abteilung für Allg. Innere Medizin, Nephrologie und Rheumatologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland

    P. Kümpers

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Kümpers, P. Volumensubstitution mit NaCl 0,9 %. Internist 56, 773–778 (2015). https://doi.org/10.1007/s00108-015-3676-1

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