Cl liberal solutions and mortality

Your fluid resuscitation treatment

  • Normal Saline (0.9%)

    Votes: 12 63.2%
  • Lactated Ringers or other lower cl- fluid

    Votes: 2 10.5%
  • Either NS or LR at your discretion

    Votes: 5 26.3%
  • Synthetic colloid solution

    Votes: 0 0.0%
  • Blood products

    Votes: 1 5.3%

  • Total voters
    19

Veneficus

Forum Chief
7,301
16
0
Today in my daily reading I came across this study:

Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults

Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M

JAMA. 2012;308:1566-1572

The long and short of it is they compared Cl- content in fluid therapy for volume resuscitation.

I found it very interesting because the conclusion was that lower Cl- fluids like lactated ringers showed no significant change in mortality.

However, they did show a significant reduction in AKI. (Which is very important not only for quality of life, but for cost as well, dialysis is expensive)

When I first started my career, for the treatment of shock, lactated ringers was the prefered solution in EMS. We weren't ever told why, only that it is.

Some years later, in the effort to save money, it was decided since studies showed no difference in 90 day mortality, it was chaper just to stock saline. (0.9%)

For years in both EMS and ED settings, saline became the "go-to" solution for resucitation. After all, in the emergency medicine "all or nothing" mentality, mortality was the same.

Now this study by itself is not without flaw and certainly not overly convincing.

But looking into it a little deeper, it seems consistently stated in both surgery and anesthesia literature that lactated ringers is the prefered solution in shock responsive to chrystalloid.

So maybe it does matter?

So, let us take a head count of what is going on.

(note, multiple answers are selectable, please only select what you have available to you, not what you wish you had)
 
Last edited by a moderator:

DesertMedic66

Forum Troll
11,268
3,450
113
We only carry NS in my area.
 

med51fl

Forum Lieutenant
114
0
0
NS is all we got as well unless the trauma copter brings blood.
 

Merck

Forum Lieutenant
137
9
18
Our street crews carry NS.

Where I work we carry NS of course but our fluid of choice is currently Plasmalyte unless we are running blood.

For the crit care stuff we monitor for Na as well as complications of administration such as hyperchloremic acidosis and will generally switch fluid if needed say to RL or D5 1/2 normal.

On the street our crews are generally fluid restricited - receiving more than a litre prehospital would be unusual.

Cheers
 

Melclin

Forum Deputy Chief
1,796
4
0
NS.

Used to carry Hartmanns. My understanding was that the change came due to cost and a lack of evidence in favour of it over saline.
 

Wheel

Forum Asst. Chief
738
2
18
We have NS and LR available. I have never seen LR used except in trauma (along with NS on blood tubing in the other line.) I may have to look into using it more.
 
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