(Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study

Abstract

In this double-blind crossover study, the effects of bolus infusions of 0.9% saline (NaCl) and Hartmann's solution on serum albumin, haematocrit and serum and urinary biochemistry were compared in healthy subjects. Nine young adult male volunteers received 2-litre intravenous infusions of 0.9% saline and Hartmann's solution on separate occasions, in random order, each over 1 h. Body weight, haematocrit and serum biochemistry were measured pre-infusion and at 1 h intervals for 6 h. Biochemical analysis was performed on pooled post-infusion urine. Blood and plasma volume expansion, estimated by dilutional effects on haematocrit and serum albumin, were greater and more sustained after saline than after Hartmann's solution (P <0.01). At 6 h, body weight measurements suggested that 56% of the infused saline was retained, in contrast with only 30% of the Hartmann's solution. Subjects voided more urine (median: 1,000 compared with 450 ml) of higher sodium content (median: 122 compared with 73 mmol) after Hartmann's than after saline (both P =0.049), despite the greater sodium content of the latter. The time to first micturition was less after Hartmann's than after saline (median: 70 compared with 185 min; P =0.008). There were no significant differences between the effects of the two solutions on serum sodium, potassium, urea or osmolality. After saline, all subjects developed hyperchloraemia (>105 mmol/l), which was sustained for >6 h, while serum chloride concentrations remained normal after Hartmann's (P <0.001 for difference between infusions). Serum bicarbonate concentration was significantly lower after saline than after Hartmann's (P =0.008). Thus excretion of both water and sodium is slower after a 2-litre intravenous bolus of 0.9% saline than after Hartmann's solution, due possibly to the more physiological [Na(+)]/[Cl(-)] ratio in Hartmann's solution (1.18:1) than in saline (1:1) and to the hyperchloraemia caused by saline.

Isotonic saline in elderly men: an open‐labelled controlled infusion study of electrolyte balance, urine flow and kidney function

“…It increased after both infusions, which is contrary to our study hypothesis, and also contrary to previous findings of a reduction of 10-15% after saline [2,4]. Although our study confirmed that the urine output was lower with isotonic saline compared with the buffered Ringer's solution [3,17,18], the difference was more dependent on pre-infusion fluid retention than on the choice of fluid. Patients with fluid retention excreted three times more fluid when receiving Ringer's acetate compared with saline (Table 2), while there was virtually no increase in urine flow in response to isotonic saline.…”

“…Isotonic saline is the most widely used infusion fluid in Europe [16], despite reports of potential harm [3,[5][6][7]17]. These warnings are not supported by the present study.…”

Improving peri-operative fluid management in a large teaching hospital: pragmatic studies on the effects of changing practice

“…Such changes, in line with the recently published UK guidance (1) , appear to yield considerable clinical benefit as judged by our pragmatic study, and these benefits are in line with those previously reported from formal clinical trials (3,4) . Our data underline the need for continuous audit of clinical practice with appropriate analysis to determine the likely impacts of change and show that relatively simple, low-cost, pragmatic methodologies can be used to assess changes in clinical practice.…”

Volume Overload: Prevalence, Risk Factors, and Functional Outcome in Survivors of Septic Shock

“…It has been theorized that the formation of endomysial edema, and an associated increase in diffusion distance from blood vessel to muscle fibers, may contribute to muscle fiber damage in patients with septic shock (38). In observational and experimental models, hyperchloremia or chloride-rich fluids have been associated with fluid retention, reduced renal perfusion, AKI, and mortality (39)(40)(41)(42)(43)(44). If any of these effects on biological systems are clinically significant, it is plausible that one or a ORIGINAL RESEARCH combination of volume-related complications could result in a prolonged hospital stay, impaired mobility, and/or need for discharge to a healthcare facility.…”