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0.9% saline solution: “physiological” or “unphysiological”?

  • Claudio Tubili
Review

Abstract

In patients who cannot, must not or do not want to drink, hydration is a real artificial nutrition intervention. Different clinical situations require a specific approach for fluid administration to reduce the risk of tissue hypoperfusion or oedema. The variations of plasma volume depend not only on the amount of the fluid infused, but also on its distribution, which is determined by the membranes’ properties. Fluids for intravenous therapy are not vehicles but real drugs and the knowledge of their properties should guide the choice: the available data on mortality and major complications do not demonstrate the best efficacy between crystalloids or colloids and between the different types of colloids: saline solution at 0.9% is commonly defined as “physiological”, but has significant differences with plasma; balanced electrolytic solutions seem to give better clinical outcomes compared to saline, which is ultimately overprescribed. 5% glucose solution is equivalent to water because glucose is rapidly metabolised, releasing it. It is necessary to strengthen educational interventions to improve the management of fluid therapy.

Keywords

Parenteral nutrition Fluids for intravenous administration 0.9% saline solution Colloids Crystalloids 

References

  1. 1.
    Campbell IT, Green CJ, Jackson MJ (1998) Muscle glycogen and electrolyte concentrations in multiple organ failure. Proc Nutr Soc 57:111AGoogle Scholar
  2. 2.
    Allison SP (1974) Metabolic aspects of intensive care. Br J Hosp Med 11:860–871Google Scholar
  3. 3.
    Price J, Sera J, Venn R (2002) Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database Syst Rev (1):CD003004Google Scholar
  4. 4.
    Holte K, Kehlet H (2002) Compensatory fluid administration for preoperative dehydration: does it improve outcome? Acta Anesthesiol Scand 4:1089–1093CrossRefGoogle Scholar
  5. 5.
    Tatara T, Tsuzaki K (1999) Measurements of extracellular water volume by bioelectrical impedance analysis during preoperative period of oesophageal resection. Masui 48:1194–1201Google Scholar
  6. 6.
    Chan ST, Kapadia CR, Johnson AW et al (1983) Extracellular fluid volume and third space sequestration at the site of small bowel anastomosis. Br J Surg 70:36–39CrossRefGoogle Scholar
  7. 7.
    Allison S (2004) Fluid, electrolyte and nutrition. Clin Med 4:573–578Google Scholar
  8. 8.
    Grocott MPW, Mythen MG, Tong JG (2005) Perioperative fluid management and clinical outcomes in adults. Anesth Analg 100:1093–1106CrossRefGoogle Scholar
  9. 9.
    Freyburger G, Dubreuil M, Boisseau MR, Janvier G (1996) Rheological properties of commonly used plasma substitutes during preoperative normovolemic acute haemodiluition. Br J Anesthesiol 76:519–525Google Scholar
  10. 10.
    Krieter H, Brückner UB, Kefalianakis F, Messmer K (1995) Does colloid-induced plasma hyperviscosity in haemodiluition jeopardize perfusion and oxygenation of vital organs? Acta Anesthesiol Scand 39:236–244CrossRefGoogle Scholar
  11. 11.
    Martin G, Wakeling H, El Malem H et al (2002) A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactate Ringer’s solution, 6% hetastarch in a balanced saline vehicle, or 6% hetastarch in a saline during major surgery. J Cardiothorac Vasc Anesthes 16:441–446CrossRefGoogle Scholar
  12. 12.
    Audibert G, Donner M, Lefevre JC et al (1994) Rheologic effects of plasma substitutes used for preoperative hemodilution. Anesthes Analg 78:740–745Google Scholar
  13. 13.
    Vincent JL (2007) Fluids resuscitation: colloids vs crystalloids. Acta Clin Belg Suppl 2:408–411Google Scholar
  14. 14.
    Rackow EC, Astiz ME, Schumer W et al (1989) Lung and muscle water after crystalloid and colloid infusion in septic rats: effects on oxygen delivery and metabolism. J Lab Clin Med 113:184Google Scholar
  15. 15.
    Katrin I, Boldt J, Suttner S et al (2001) Colloids vs crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesthesiology 93:405–409Google Scholar
  16. 16.
    Roberts I, Alderson P, Bunn F et al (2007) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev (4):CD000567Google Scholar
  17. 17.
    Bunn F, Trivedi D, Ashraf S (2008) Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev (1):CD001319Google Scholar
  18. 18.
    Gan TJ, Bennett-Guerrero E, Phillips-Bute B et al (1999) Hextend, physiologically a balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial-study Hextend group. Anesth Analg 88:992–998CrossRefGoogle Scholar
  19. 19.
    Cochrane Injuries Group Albumin Reviewers (1998) Human albumin administration in critically ill patients, systematic review of randomized controlled trials. BMJ 317:235–240Google Scholar
  20. 20.
    Vincent JL, Navickis RJ, Wilkes MM (2004) Hospitalized morbidity in patients receiving human albumin: a metanalysis of randomized controlled trials. Crit Care Med 32:2029–2038CrossRefGoogle Scholar
  21. 21.
    Finfer S, Bellomo R, Boyce N et al; The SAFE Study Investigators (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256CrossRefGoogle Scholar
  22. 22.
    SAFE Study Investigators (2006) Effect of baseline serum albumin concentration on outcome of Resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study. BMJ 333:1044CrossRefGoogle Scholar
  23. 23.
    The SAFE Study Investigators (2007) Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med 357:874–884CrossRefGoogle Scholar
  24. 24.
    Stephens R, Mythen MG (2003) Optimizing intraoperative fluid therapy. Curr Opin Anaesthesiol 16:385–392CrossRefGoogle Scholar
  25. 25.
    Heller MB, Crocco T, Prestoh JC, Patterson JW (1996) Effectiveness of different crystalloid i.v. solution in establishing urine flow. J Emerg Med 14:1–3CrossRefGoogle Scholar
  26. 26.
    Lobo DN, Stanga Z, Simpson JA, Anderson JA (2001) Dilution and redistribution effects of rapid infusion of 2 l saline 0.9% and 5% dextrose on haematological parameters and serum biochemistry in normal subjects: a double blind cross over study. Clin Sci 101:173–179CrossRefGoogle Scholar
  27. 27.
    Porta M, Tomelini M, Borgo E et al (2006) A phylogenetic approach to salt and hypertension. Giorn Ital Diabetol Metab 26:18–34Google Scholar
  28. 28.
    Reid F, Lobo DN, Williams RN et al (2003) (Ab) normal saline and physiological Hartmann’s solution: a randomized doubleblind cross over study. Clin Sci 104:17–24CrossRefGoogle Scholar
  29. 29.
    Wilkes NJ, Woolf R, Mutch M et al (2001) The effects of balanced versus saline based hetastarch and crystalloid solutions on acid base and electrolyte status in elderly surgical patients. Anesth Analg 93:811–816CrossRefGoogle Scholar
  30. 30.
    Lobo DN (2004) Fluid, electrolytes and nutrition: physiological and clinical aspects. Proc Nutr Soc 63:453–466CrossRefGoogle Scholar
  31. 31.
    Brady M, Kinn S, Stuart P (2003) Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev (4):CD004423Google Scholar
  32. 32.
    Ackland GL, Singh-Ranger D, Fox S et al (2004) Preoperative assessment of fluid depletion using bio impedance analysis. Br J Anaesth 92:134–136CrossRefGoogle Scholar
  33. 33.
    Sanders G, Mercer S, Saeb-Parsey K et al (2001) Randomized clinical trial of intravenous fluid replacement last preparation for bowel surgery. Br J Surg 88:1363–1365CrossRefGoogle Scholar
  34. 34.
    Sigurdsson GH (1995) Perioperative fluid management in microvascular surgery. J Reconstr Microsurg 11:57–65CrossRefGoogle Scholar
  35. 35.
    Brandstrup B, Tonnesen H, Beier-Holgersen R et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimen — a randomized assessor-blinded multicenter trial. Ann Surg 238:641–648CrossRefGoogle Scholar
  36. 36.
    Lobo DN, Bostock KA, Neal KR et al (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomized controlled trial. Lancet 359:1812–1818CrossRefGoogle Scholar
  37. 37.
    Mecray PM, Barden RP, Ravdin IS (1937) Nutritional edema: its effects on the gastric emptying time before and after gastric operations. Surgery 1:53–64Google Scholar
  38. 38.
    Wilmore DW, Smith RJ, O’Dwyer ST et al (1988) The gut: a central organ following surgical stress. Surgery 104:917–923Google Scholar
  39. 39.
    Hamilton-Davies C, Mythen MG, Salmon JB et al (1997) Comparison of commonly used clinical indicators of hypovolemia with gastrointestinal tonometry. Intensive Care Med 23:276–281CrossRefGoogle Scholar
  40. 40.
    Lobo DN (2008) Water and salt balance. XX Espen Congress, Florence, 12–15 SeptemberGoogle Scholar
  41. 41.
    Arkilic CF, Taguchi A, Sharma N et al (2003) Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 133:49–55CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  1. 1.Diabetes UnitS. Camillo Forlanini HospitalRomeItaly
  2. 2.I.N.M.I. “L. Spallanzani”RomeItaly

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