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We get used to Fluids Resuscitation with Normal Saline, sometimes we tend to forget to monitor it!! If I tell you “nothing normal about normal saline”. Would you agree/ disagree, please justify your response. After the poll I’ll be sharing some key articles on that
Stay tuned tonight for #saltythread
In this thread I’ll shed some light on Why “nothing is normal about normal saline”
Normal saline belongs to group of crystalloids known as “Unbalanced crystalloids” this term by itself is enough to remind you that normal saline is not NORMAL!
Normal saline belongs to group of crystalloids known as “Unbalanced crystalloids” this term by itself is enough to remind you that normal saline is not NORMAL!
The comparison usually done versus the other group of crystalloids “Balanced” such as RL..etcTo start we need to address that the Na & Cl content are the key in dividing the above mention crystalloids,mainly Cl. NS has 154 mEq/L of each, RL has less Cl =109 and 130mEq/L of Na.
This difference also motivates clinicians to call NS “Cl rich solutions”& RL”Cl restrictive solution”These differences might be not of huge impact when it comes to maintenance IV fluids but in large fluids resuscitation in critically ill pts the impact of salt content is crucial.
Effect of high Cl content in critically ill patients is still controversial but could result in severe renal, cardiac or hepatic complications. There are multiple studies address this I’ll tackle some of them here.
The SPLIT Trial 2015: To determine the effect of a Buffered Crystalloid Solution vs Saline on AKI Among Patients in the ICU. Concluded that patients receiving crystalloid fluid therapy in the ICU, use of a buffered crystalloid compared with saline did not reduce the risk of AKI.
The SALT Trial 2017: To compare Balanced Crystalloids versus Saline in the Intensive Care Unit. Found no differences between the gps, however in pts received larger volume of isotonic saline gp experiences higher incidence of MAKE30 (major adverse kidney events within 30 days).
Another SALT-ED trial published in 2018 for non-critical patients concluded that use of balanced crystalloids is associate with reduction in major kidney events.
The SMART Trial 2018: To compare Balanced crystalloids versus Saline in critically ill adults.Concluded that Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in lower rate of the composite outcome of death from any cause.
