Articles That May Change Your Practice: Balanced Crystalloids Revisited

Published:September 07, 2022DOI:
      Intravenous fluids are commonly administered in the critical care setting; yet, the question of which fluid is associated with the best clinical outcome remains unclear. Historically, 0.9% sodium chloride (“normal saline”) is the most frequently used resuscitation fluid, but several studies have linked it with hyperchloremic metabolic acidosis, acute kidney injury, and death. Increasingly, balanced crystalloid solutions, such as lactated Ringer solution or Plasma-Lyte A Baxter Healthcare Corporation, Deerfield, IL, USA, have been used as an alternative to normal saline. Several studies suggested that the use of crystalloid solutions resulted in decreased acute kidney injuries, decreased renal replacement therapy, and lower rates of death.
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        • Semler MW
        • Self WH
        • Wanderer JP
        • et al.
        Balanced crystalloid versus saline in critically ill adults.
        N Engl J Med. 2018; 378: 829-839


      Russell D. MacDonald, MD MPH FRCPC DRCPSC, is the former medical director at Ornge Transport Medicine; the current medical director at Toronto Paramedic Services; a professor in the Faculty of Medicine at the University of Toronto; and an attending staff member at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. He can be reached at [email protected].


      Joshua G. Campbell, MD is a resident physician at Vanderbilt University Medical Center in Nashville, TN.


      Aaron J. Lacy, MD FAWN, is an assistant professor of emergency medicine at Washington University School of Medicine in St Louis, MO.


      Jeremy B. Brywczynski MD FACEP, is the medical director for Vanderbilt LifeFlight, associate medical director of the Nashville Fire Department, and an associate professor of emergency medicine at Vanderbilt University Medical Center.