Saline Is Not the First Choice for Crystalloid Resuscitation Fluids

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Fluid resuscitation with crystalloid solutions is among the most common interventions for hospitalized patients. Currently, providers choose between two classes of available crystalloid solutions: 0.9% sodium chloride (saline) and “balanced” crystalloids (such as lactated Ringer solution [ Baxter, Deerfield, IL], Hartmann solution [B. Braun Melsungen AG, Melsungen, Germany], or Plasma-Lyte [Baxter, Old Toongabbie, NSW, Australia]). Although often used interchangeably, saline and balanced crystalloids differ in composition in ways that may impact patients. Given the similar availability and cost of each fluid, along with mounting evidence linking saline to metabolic derangements, acute kidney injury, and mortality, we will argue in this viewpoint that saline should not be the first choice for crystalloid resuscitation fluid.
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