A long time ago..
A junior doctor asks the attending:
What type of fluid would you choose on this patient, Saline or Ringer’s?
▪️A: I’ll take the usual, Saline.
Does it really matter? They are both crystalloids with salt, right?
Here are the main reasons Saline is WRONG.
✔ Saline causes hyperchloremic acidosis in a dose-dependent manner.
Not only on sick people, a volume of 2000 ml of chloride-rich infusate may induce hyperchloremic metabolic acidosis in healthy volunteers
Now we know, it causes Hyperchloremic acidosis in a dose dependent manner.
How does the ab-Normal Saline (NS) causes harm?
Did you know that the average pH of commercial 0.9% saline is around 5.5? In fact, Hartmann’s pH is also around 5. In vitro acidity is irrelevant.
What is the main mechanism of that explain in vivo hyperchloremic acidosis by NS?
What is the clinical translation of this effects?
There was this SIGNAL of bad outcomes with saline in comparison with plasma-lyte, on this large database of almost half a million surgical patients!
👉IV fluids are drugs, with indications, doses, targets.
👉Stop de NS inertia, think twice
👉NS causes ⬆Cl-, ⬆H+ and is bad, specially for the kidneys
👉Choose SMARTly balanced solutions (RL, HT, PL)