The case for 0.9% NaCl: is the undefendable, defensible?

Abstract

Although 0.9% NaCl solution is by far the most-used fluid for fluid therapy in resuscitation, it is difficult to find a paper advocating its use over other types of crystalloid solutions. Literature on the deleterious effects of 0.9% NaCl has accumulated over the last decade, but critical appraisal of alternative crystalloid solutions is lacking. As such, the literature seems to suggest that 0.9% NaCl should be avoided at all costs, whereas alternative crystalloid solutions can be used without scrutiny. The basis of this negative evaluation of 0.9% NaCl is almost exclusively its effect on acid-base homeostasis, whereas the potentially deleterious effects present in other types of crystalloids are neglected. We have the challenging task of defending the use of 0.9% NaCl and reviewing its positive attributes, while an accompanying paper will argue against the use of 0.9% NaCl. It is challenging because of the large amount of literature, including our own, showing adverse effects of 0.9% NaCl. We will discuss why 0.9% NaCl solution is the most frequently used resuscitation fluid. Although it has some deleterious effects, all fluids share common features of concern. As such the emphasis on fluid resuscitation should be on volume rather than on composition and should be accompanied by a physiological assessment of the impact of fluids. In this paper, we hope to discuss the context within which fluids, specifically 0.9% NaCl, can be given in a safe and effective manner.

The Central Role of Renal Microcirculatory Dysfunction in the Pathogenesis of Acute Kidney Injury

“…The most used fluid in resuscitation, i.e. 0.9% NaCl, has been especially implicated in this respect and its use as a resuscitation fluid is a subject of controversy [30,31]. It is clear, however, that the administered volume is the key issue that determines the extent to which fluid therapy is deleterious to renal function.…”

Balanced Crystalloid Solution Versus Normal Saline on Biochemical Outcomes in Acute Medical and Surgical Patients

“…NS infusions have been associated with greater chloride administration and high rates of resultant renal dysfunction in some cases [1,11]. On the contrary, recent evidences in both the critical and noncritical care setting (with both small and large volume infusions), have suggested that there is no significant difference in severe AKI rates when comparing NS to a balanced crystalloid solution [2,7,8,10]. Our data add to the literature investigating the effects of intravenous infusions on AKI incidence.…”

“…2018;7(2):39-44 also further exploring the effects of infusing NS with lower volumes (typically volumes less than 3 L per 24 h), than in the critically ill population [1,2]. Our study therefore aimed to investigate any significant biochemical effects of maintenance intravenous NS infusions compared to a buffered crystalloid solution, compound sodium lactate (CSL), in acute general medical and surgical patients with a variety of diagnoses.…”

“…Well-established theories have been put forth explaining the process of saline-induced acidosis, including the proposal that the increase in chloride ion concentration and the dilution of bicarbonate results in systemic acidosis [1,2].…”

Якісна Клінічна Практика Стартової Інтенсивної Терапії При Бойовій І Цивільній Політравмі (Огляд Літератури)

“…Сбалансированные солевые растворы (растворы с физиологическим значением рН и изотонической концентрацией электролитов), будучи более физио-логичными, используются чаще, в том числе в каче-стве среды, несущей коллоид [12]. Сбалансированные растворы по солевому составу идентичны человече-ской плазме, имеют более низкое содержание натрия и хлорида, чем 0,9% раствор хлорида натрия, и добав-ление в качестве буферного раствора ацетата или лак-тата.…”