An interesting article and an editorial from Anesthesia Analgesia:
It is becoming more clear that the hyperchloremia associated with infusion of normal saline is not benign:
Hyperchloremic metabolic acidosis is not a benign, self-limiting, metabolic disturbance. We found that acute postoperative hyperchloremia in patients undergoing noncardiac surgery was associated with increased mortality, renal dysfunction, and length of hospital stay.
As the editorial points out, several things are clear:
- hyperchloremia is more common with 0.9% saline than with balanced crystalloid solutions
- hyperchloremia is associated with worse outcomes
- there are better alternatives to 0.9% saline in most clinical situations (excluding hypochloremic metabolic alkalosis)
- until an adequately powered randomized clinical trial proves us wrong, 0.9% saline will not be our crystalloid of choice for intravascular volume resuscitation in surgical patients.