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Thursday, March 1, 2018

Normal saline for resuscitation

PulmCrit (EmCrit)
PulmCrit - February 27, 2018 - By Josh Farkas
  • “Normal” saline is a hypertonic, acidotic fluid. There is no physiologic rationale for its use as a resuscitative fluid.
  • There are many potential problems related to saline. These include causing hyperchloremic acidosis, hyperkalemia, hemodynamic instability, renal malperfusion, systemic inflammation, and hypotension.
  • Numerous small RCTs have emerged over the past few years which highlight various problems with saline resuscitation.
  • The SMART and SALT-ED trials are massive, multiple-crossover trials which compare saline versus balanced crystalloids among critically ill and non-critical patients. Both studies found a 1% increase in death or renal failure with the use of saline.
  • The combination of physiology, animal studies, numerous RCTs, SMART, and SALT-ED indicate that it's time to stop resuscitating with saline."