IV Solutions

[TheLocalMedic]

As far as I'm concerned, there isn't much of a difference between LR and NS for EMS providers. Even with long transport times (and I hear ya, I worked in a system where we had >1 hr transports) the acidosis factor really doesn't come into play. If a patient needs a full two liters en route then they're really really sick, and probably the last thing I'm worried about is their acid-base balance. Try to maintain a SBP of 90 mmHg, giving tons of fluids (especially in traumas) just leads to you diluting their existing volume. Even severe dehydration or heat stroke cases don't really benefit much more from one than the other.

 

[EMT B]

forgive me if im not thinking clearly or if ive got my stuff bass ackwards, but how is NS going to cause acidosis over a long period of time? its an isotonic solution...

also wouldn't LR be a better choice for your traumas because of the volume expanding properties of the electrolyte solution?

 

[VFlutter]

Saline Induced Hyperchloremic Metabolic Acidosis

 

[Carlos Danger]

forgive me if im not thinking clearly or if ive got my stuff bass ackwards, but how is NS going to cause acidosis over a long period of time? its an isotonic solution...

Hyperchloremia with large volume infusions (like 8+ liters).

also wouldn't LR be a better choice for your traumas because of the volume expanding properties of the electrolyte solution?

LR expands volume no more than NS. Neither exert osmotic pressure, and neither remain in the vascular space for very long.

LR is considered by many to be a better choice because large volumes of it are thought less likely to promote acidosis than large volumes of NS.

 

[Aprz]

forgive me if im not thinking clearly or if ive got my stuff bass ackwards, but how is NS going to cause acidosis over a long period of time? its an isotonic solution...

also wouldn't LR be a better choice for your traumas because of the volume expanding properties of the electrolyte solution?

Isotonic just means the osmotic pressure is similar to blood. Hypertonic, blood is drawn outta cells into vascular space. Hypotonic, fluids go into the swells causing it swell.

Even though there is equal amount of Na+ and Cl- at first, the Na+ is depleted/gotten rid of from the body more quickly. The Cl- becomes HCl.

 

[fma08]

For those interested (and who have access), there is a review article on Resuscitation Fluids in the New England Journal of Medicine. I haven't looked at it thoroughly yet. Can't seem to find it online for whatever reason. But it is in the Sept. 26th issue. (Vol 369 NO 13).

 

[CentralCalEMT]

In one of the counties I work in, we have LR for volume replacement and that is the primary fluid we use. However, we also have NS in case we need to push medications such as mag sulfate. We also have D5W for our lido drips. However on 99% of patients where you are simply hanging a bag, we use LR.

In the other county I work in, we use NS for most everything. Thanks to the nationwide shortage of D50, we also carry D10 and give a bolus of that to hypoglycemic patients.

 

[NomadicMedic]

We occasionally restock at a Maryland Hospital and the primary fluid used there is LR. It's easy to grab the wrong bag in a hurry, but there always a flood of emails "make sure you get the correct fluid" when somebody restocks gear with a LR bag instead of Normal Saline.

 

[Handsome Robb]

Another common cause of metabolic acidosis is diabetic ketoacidosis(DKA) from hyperglycemia - the primary treatment pre-hospital is a fluid bolus of NSS. So here you can sort of see that NSS does not promote acidosis until given in high volumes such as 2-3 liters and the body is not able to adjust itself to maintain the normal balance which would be the case in severe traumatic injury.

ResTech,I agree that it's a great post. One thing I don't understand though is we've established that NSS in large infusions can promote acidosis. During DKA these patients require massive amounts of fluids so is NSS really the right choice when managing them seeing as the only treatment thats practiced and in my opinion appropriate in the prehospital setting is fluid boluses. Is the limited time we're with these patients enough reason to not consider the potential to worsen the acidosis or is this a situation where we'd be better off with LR?