College of Pharmacy
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HelixTalk Episode #92 - Why You Should Stop Using (Ab)normal Saline: NS vs. LR for IV Fluids
Date posted: March 5, 2019, 6:00 am
In this episode, we discuss IV fluids for hospitalized patients, including normal saline (0.9% NaCl) and lactated ringer’s. In addition, we review the newest literature supporting the use of balanced crystalloids over normal saline from the SMART and SALT-ED trials.
- There’s nothing normal about normal saline -- it contains too much chloride and is too acidic. Even “standard” doses of normal saline produce electrolyte abnormalities and can be nephrotoxic compared to balanced crystalloids.
- “Balanced” crystalloids are IV fluids that are matched to the pH and electrolyte concentrations of human plasma. The most common balanced crystalloid is lactated ringer’s (LR), but many other products exist.
- Largely due to its calcium content, lactated ringer’s has many IV incompatibilities that can be problematic in patients who have limited IV line access.
- Lactated ringer’s does not worsen lactic acidosis and it does not cause hyperkalemia.
- Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018 Mar 1;378(9):829-839.
- Self WH, Semler MW, Wanderer JP, et al. Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med. 2018 Mar 1;378(9):819-828.