This article appeared in the New England Journal of Medicine:
Particularly important is the section on crystalloids.
Some important aspects are highlighted.
This manuscript helps us get closer to stopping the knee jerk use of so-called normal saline as the “resuscitation fluid of choice” and for the dilution of packed red blood cells.
The real indication for normal saline resuscitation is traumatic brain injury (TBI) and hyponatremia/hypochloremia.
Except in cases of TBI and hyponatremia/hypochloremia, plasmalyte is a much better resuscitation fluid, as it does not cause hyperchloremic acidosis and it is compatible with the infusion of packed red blood cells.
The bottom lines:
Although the use of resuscitation fluids is one of the most common interventions in medicine, no currently available resuscitation fluid can be considered to be ideal.
In light of recent high quality evidence, a reappraisal of how resuscitation fluids are used in acutely ill patients is now required.
The selection, timing, and doses of intravenous fluids should be evaluated as carefully as they are in the case of any other intravenous drug, with the aim of maximizing efficacy and minimizing iatrogenic toxicity.