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Name of Media:

Balanced electrolyte solutions give marginal benefit over saline for very ill patients


University of Southampton and Bazian

Publisher or Source:

NIHR Dissemination Centre

Type of Media:

Medical Professional Education

Media Originally for:

Critical Care Physicians

Country of Origin:

United Kingdom of Great Britain and Northern Ireland (the)

Primary Focus of Media:

Pre-Use of PICS Designation

COVID-19 Related:



About 14% of critically ill patients receiving electrolyte-balanced crystalloids either developed kidney failure, needed kidney-replacement therapy or died compared with 15% receiving normal saline. This small but statistically significant benefit was only apparent when combining outcomes; there was no difference between fluids for the three individual outcomes analysed separately.

A solution of 0.9% sodium chloride (normal saline) is the most commonly used intravenous (IV) fluid, but it can cause biochemical imbalance. Alternative crystalloids like Ringer's lactate or Hartmann’s solution contain an electrolyte composition closer to normal blood fluid and are often seen as preferable.

This US trial compared 30-day outcomes for over 15,000 critical patients randomised to either fluid type. The difference in outcomes between fluid types was very small, but there is a difference in cost.

The small benefit perhaps argues against routine use of balanced crystalloids in all patients. Though what is most important is that the fluid and electrolyte needs of the individual are recognised and met.

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