Abstract
The present review of fluid therapy studies using balanced solutions versus isotonic saline fluids (both crystalloids and colloids) aims to address recent controversy in this topic. The change to the acid-base equilibrium based on fluid selection is described. Key terms such as dilutional-hyperchloraemic acidosis (correctly used instead of dilutional acidosis or hyperchloraemic metabolic acidosis to account for both the Henderson-Hasselbalch and Stewart equations), isotonic saline and balanced solutions are defined. The review concludes that dilutional-hyperchloraemic acidosis is a side effect, mainly observed after the administration of large volumes of isotonic saline as a crystalloid. Its effect is moderate and relatively transient, and is minimised by limiting crystalloid administration through the use of colloids (in any carrier). Convincing evidence for clinically relevant adverse effects of dilutional-hyperchloraemic acidosis on renal function, coagulation, blood loss, the need for transfusion, gastrointestinal function or mortality cannot be found. In view of the long-term use of isotonic saline either as a crystalloid or as a colloid carrier, the paucity of data documenting detrimental effects of dilutional-hyperchloraemic acidosis and the limited published information on the effects of balanced solutions on outcome, we cannot currently recommend changing fluid therapy to the use of a balanced colloid preparation.
Highlights
Normal saline solution has been used for over 50 years in a multitude of clinical situations as an intraoperative, resuscitation and maintenance fluid therapy
Excessive use of saline has been observed to result in hyperchloraemic acidosis – which has been identified as a potential side effect of salinebased solutions
This study found that recipients undergoing kidney transplants had greater acidosis and higher potassium concentrations if they were given isotonic saline as opposed to Ringer’s lactate [31]
Summary
Normal saline solution has been used for over 50 years in a multitude of clinical situations as an intraoperative, resuscitation and maintenance fluid therapy. The resulting diuresis of hypotonic urine causes the serum osmolality to return quickly to normal These changes in osmolarity must be taken into account in the interpretation of clinical studies comparing Ringer’s lactate with isotonic saline. Boldt and colleagues compared the effects of very high doses (around 18 litres in 48 hours) of Ringer’s lactate and isotonic saline in patients undergoing abdominal surgery (Table 3) [16]. Comparing HES 130/0.42 in balanced solution with albumin in saline as a priming solution for cardiopulmonary bypass, Boldt and colleagues reported small but significant differences in coagulation (Rotem, Pentapharm, Munich, Germany) in favour of the balanced HES This observation was associated with significantly lower blood loss [20]. Maciel and Park have reported similar results [52]
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