Hypotonic vs isotonic saline solutions for intravenous fluid management of acute infections.

Abstract

Hypotonic saline is commonly used as maintenance fluid in the management of acute infections. In recent years use of a hypotonic saline has been associated with adverse outcomes. To reduce the rates of adverse outcomes, use of isotonic saline as maintenance fluid has been suggested. To asses adverse events and benefits associated with infusion of hypotonic saline compared to isotonic saline solutions in the management of acute infections. We searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, current controlled trials and the Specialised register of the Injuries Group. Randomised trials comparing hypotonic saline to isotonic saline in the management of acute infections. Three reviewers independently evaluated all potentially relevant articles, examined each study for possible inclusion and assessed the methodology quality using the Cochrane guidelines. No trials met our inclusion criteria. We found no randomised controlled evidence to show that use of isotonic saline as a maintenance fluid instead of a hypotonic saline will lead to an improvement in outcomes. Randomised trials with adequate design and sample sizes are needed to evaluate the possible advantages and risks of using isotonic saline as maintenance fluid.