What’s new on balanced crystalloid solutions?
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Intravenous fluid therapy is fundamental to the management of acutely ill patients and includes fluid resuscitation to treat hypovolaemia, replacement of ongoing fluid loses, and the provision of maintenance fluids to meet basal requirements for patients unable to drink. A range of crystalloid fluids are available including 0.9 % saline (saline), glucose solutions, and various balanced crystalloids . Saline contains 154 mmol/L of chloride compared with ~100 mmol/L in normal human plasma. While balanced crystalloids have chloride concentrations more closely approximating plasma, they contain anions such as lactate and acetate in non-physiological concentrations.
The infusion of saline has been associated with hyperchloraemic metabolic acidosis and a reduced glomerular filtration rate , and its use may result in hypernatraemia. Balanced crystalloids may also have potentially harmful effects. In particular, as all balanced crystalloids are relatively alkaline compared to saline,...
KeywordsRenal Replacement Therapy Acute Kidney Injury Fluid Resuscitation Metabolic Alkalosis Balance Crystalloid
Compliance with ethical standards
The Medical Research Institute of New Zealand receives Independent Research Organisation funding from the Health Research Council of New Zealand. Dr Young reports receiving partial funding for his institution to conduct the Saline vs. Plasma-Lyte 148® for ICU fluid therapy (SPLIT) study. The Plasma-Lyte 148® vs. Saline (PLUS) study is partially funded by Baxter. Professor Finfer declares his employers have received research funding and reimbursement of travel expenses from CSL Behring, Fresenius Kabi and Baxter.
Conflicts of interest
Professor Machado receives research funding from the Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) and declares no conflict of interest.
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