Baxter: Not all crystalloids are created equal

IV therapy should ensure optimal fluid and electrolyte balance during resuscitation and replacement therapy. Recent studies have highlighted the risks associated with the use of HES Colloids in specific patient groups, including increased need for renal replacement therapy1,2 anaphylactoid reactions3 and increased mortality.

Current international IV fluid management guidelines recommend the use of crystalloid solutions for both resuscitation and replacement therapy.4,5,6,7

But what are the key considerations when choosing the optimal crystalloid to meet all the needs of critically ill patients?

Chloride content

0.9% Sodium Chloride has a chloride level well above human serum levels.8 Despite commonly being referred to as Normal Saline, the properties of 0.9% Sodium Chloride are not entirely physiological.9 Studies have shown that infusion of large amounts of 0.9% Sodium Chloride are associated with hyperchloraemic acidosis, which can be deleterious.9 It has been suggested that the positive benefits of 0.9% Sodium Chloride on blood and plasma volume expansion are achieved at the expense of the production of significant and sustained hyperchloraemia.

The potential downsides of 0.9% Sodium Chloride are not limited to hyperchloraemia. In one study comparing 0.9% Sodium Chloride with a multiple electrolyte injection balanced crystalloid solution, twelve healthy adult males received 2-litre IV infusions over 1 hour of either solution in a randomised, double-blind manner. Not only did 0.9% Sodium Chloride lead to sustained hyperchloraemia (P<0.0001) but also to greater decreases in strong ion difference (P=0.025), significant reduction in mean renal artery flow velocity (P=0.029) and renal cortical tissue performance from baseline.

Patient Outcomes A retrospective observational study performed to evaluate adult patients undergoing major abdominal surgery who either received 0.9% Sodium Chloride or Multiple Electrolyte Solution on the day of surgery found that the Multiple Electrolyte Solution was associated with less postoperative morbidity.11

Retrospective observational study of the Premier Database was performed to evaluate adult patients undergoing major abdominal surgery who either received 0.9% Sodium Chloride (30,994 patients in total, and 2778 in matched cohort) or a balanced crystalloid solution (926 patients) on the day of surgery. Adapted from Shaw study.

This same study also showed the in-hospital mortality rate to be significantly lower (p<0.0001) in the multiple electrolyte solution arm compared to the group receiving 0.9% Sodium Chloride.

A separate 2013 retrospective analysis also showed 30 day morality to be increased in patients with acute postoperative hyperchloermia.

For more information, contact your local Baxter representative today or call Baxter OneCall Medical Information on 1300 302 409.