Sodium chloride 0.9% versus Lactated Ringer in the management of severely dehydrated patients with choleriform diarrhoea

Cieza, Javier; Hinostroza, Juana; Huapaya, Julio; León, Cristian

doi:10.3855/jidc.2531

Cited by 18 publications

(15 citation statements)

References 9 publications

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“…Similar findings were noted in studies that examined the effects of different infusions in treating dehydration 76 , 77 and acute pancreatitis. 78 A double-blind study randomized 90 consecutive moderate-to-severely dehydrated adults to receive 0.9% saline, RL, or Plasma-Lyte at 20 ml/kg/h for 2 h. 77 At the end of the study infusions, serum bicarbonate concentrations decreased leading to a tendency to lower pH values in the saline group.…”

Section: Balanced Crystalloids and Serum Potassium Concentrationsupporting

confidence: 81%

“… 77 An observational study of 40 dehydrated patients with choleriform diarrhea examined the effects of treatment with 50 ml/kg/h of either RL or 0.9% saline. 76 RL led to quicker resolution of acidosis, whereas the hyperosmolar and hypernatremic states were corrected with both solutions. Although the saline group had lower serum potassium concentrations at baseline, there were no significant differences in potassium concentrations at 2 and 14 h following infusion of the study fluids.…”

Section: Balanced Crystalloids and Serum Potassium Concentrationmentioning

confidence: 96%

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Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent ‘pre-renal’ acute kidney injury?: con

Lobo

Awad

2014

Kidney International

132

106

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The high chloride content of 0.9% saline leads to adverse pathophysiological effects in both animals and healthy human volunteers, changes not seen after balanced crystalloids. Small randomized trials confirm that the hyperchloremic acidosis induced by saline also occurs in patients, but no clinical outcome benefit was demonstrable when compared with balanced crystalloids, perhaps due to a type II error. A strong signal is emerging from recent large propensity-matched and cohort studies for the adverse effects that 0.9% saline has on the clinical outcome in surgical and critically ill patients when compared with balanced crystalloids. Major complications are the increased incidence of acute kidney injury and the need for renal replacement therapy, and that pathological hyperchloremia may increase postoperative mortality. However, there are no large-scale randomized trials comparing 0.9% saline with balanced crystalloids. Some balanced crystalloids are hypo-osmolar and may not be suitable for neurosurgical patients because of their propensity to cause brain edema. Saline may be the solution of choice used for the resuscitation of patients with alkalosis and hypochloremia. Nevertheless, there is evidence to suggest that balanced crystalloids cause less detriment to renal function than 0.9% saline, with perhaps better clinical outcome. Hence, we argue that chloride-rich crystalloids such as 0.9% saline should be replaced with balanced crystalloids as the mainstay of fluid resuscitation to prevent ‘pre-renal' acute kidney injury.

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Section: Balanced Crystalloids and Serum Potassium Concentrationsupporting

confidence: 81%

Section: Balanced Crystalloids and Serum Potassium Concentrationmentioning

confidence: 96%

Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent ‘pre-renal’ acute kidney injury?: con

Lobo

Awad

2014

Kidney International

132

106

View full text Add to dashboard Cite

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“…Infusion of chloride-rich solutions has been associated, although not consistently, with poor kidney outcomes [e.g., creatinine increase and increased need for renal replacement therapy (RRT); Table 2] [5,[24][25][26][27][28][29][30]31 & ,32 && ]. In a sequential before-and-after study, the use of balanced (Hartmann solution or Plasmalyte) or chloride-poor (20% albumin) solutions during a 6-month period reduced AKI incidence and RRT requirements compared to the previous period when chloride-rich crystalloid and colloid solutions were used [24,33 && ].…”

Section: Balanced Versus Unbalanced Crystalloidsmentioning

confidence: 99%

Are all fluids bad for the kidney?

Mårtensson

Bellomo

2015

Current Opinion in Critical Care

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“…Infusion of 0.9 % saline induces hyperchloraemia and metabolic acidosis in healthy individuals and surgical patients [ 8 – 13 ]. Similarly, resuscitation of critically ill patients with crystalloids containing supra-physiologic chloride concentrations has been associated with higher rates of hyperchloraemia, metabolic acidosis and clinical complications versus resuscitation with balanced crystalloids [ 14 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS

et al. 2014

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PurposeRecent data suggest that both elevated serum chloride levels and volume overload may be harmful during fluid resuscitation. The purpose of this study was to examine the relationship between the intravenous chloride load and in-hospital mortality among patients with systemic inflammatory response syndrome (SIRS), with and without adjustment for the crystalloid volume administered.MethodsWe conducted a retrospective analysis of 109,836 patients ≥18 years old that met criteria for SIRS and received fluid resuscitation with crystalloids. We examined the association between changes in serum chloride concentration, the administered chloride load and fluid volume, and the ‘volume-adjusted chloride load’ and in-hospital mortality.ResultsIn general, increases in the serum chloride concentration were associated with increased mortality. Mortality was lowest (3.7 %) among patients with minimal increases in serum chloride concentration (0–10 mmol/L) and when the total administered chloride load was low (3.5 % among patients receiving 100–200 mmol; P < 0.05 versus patients receiving ≥500 mmol). After controlling for crystalloid fluid volume, mortality was lowest (2.6 %) when the volume-adjusted chloride load was 105–115 mmol/L. With adjustment for severity of illness, the odds of mortality increased (1.094, 95 % CI 1.062, 1.127) with increasing volume-adjusted chloride load (≥105 mmol/L).ConclusionsAmong patients with SIRS, a fluid resuscitation strategy employing lower chloride loads was associated with lower in-hospital mortality. This association was independent of the total fluid volume administered and remained significant after adjustment for severity of illness, supporting the hypothesis that crystalloids with lower chloride content may be preferable for managing patients with SIRS.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-014-3505-3) contains supplementary material, which is available to authorized users.

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Sodium chloride 0.9% versus Lactated Ringer in the management of severely dehydrated patients with choleriform diarrhoea

Cited by 18 publications

References 9 publications

Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent ‘pre-renal’ acute kidney injury?: con

Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent ‘pre-renal’ acute kidney injury?: con

Are all fluids bad for the kidney?

Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS

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