[Abnormal saline's swan song]

Ned Tijdschr Geneeskd. 2018 Jun 7:162:D2957.
[Article in Dutch]

Abstract

We previously suggested that choosing balanced solutions over normal saline for fluid therapy might benefit patients. After all, administration of NaCl 0.9% invokes metabolic acidosis and hyperchloraemia which was linked to renal failure and mortality in retrospective studies. Two large randomized controlled clinical trials now confirm this signal. Both in intensive care patients and in the setting of emergency medicine, balanced solutions were shown to reduce the incidence of MAKE30, a composite end point of hospital mortality and indices of renal failure. In addition, predefined subgroup analysis revealed increased mortality for normal saline in intensive care patients with sepsis. Even though the effect size is small in both studies, this evidence against normal saline is hard to ignore, given the immense number of patients who receive NaCl 0.9% worldwide. Therefore, clinical medicine may shortly witness the quiet disappearance of normal saline.

Publication types

  • Review

MeSH terms

  • Critical Care
  • Electrolytes / administration & dosage
  • Electrolytes / adverse effects
  • Fluid Therapy / adverse effects
  • Fluid Therapy / methods
  • Hospital Mortality
  • Humans
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Ringer's Lactate / administration & dosage
  • Ringer's Lactate / adverse effects
  • Saline Solution / administration & dosage
  • Saline Solution / adverse effects*
  • Sepsis / therapy

Substances

  • Electrolytes
  • Ringer's Lactate
  • Saline Solution
  • Plasmalyte A