University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Emergency Medicine


Dr. Bernard Toney



Purpose: The purpose of this article is to review when there is clinical significance in recommending the use of a balanced crystalloid versus normal saline in the hospital setting.

Method: A literature review of PubMed was conducted, focused on Lactated Ringers, normal saline, balanced crystalloid, and unbalanced crystalloid. Eleven pertinent articles were chosen as the basis for this clinical review.

Results: The choice of when to use a balanced crystalloid versus normal saline becomes more clinically significant as the severity of illness and volume of fluid required increase. Research has demonstrated an increase in the length of hospital stay, adverse renal events, and overall mortality in critically ill patients receiving large volumes of balanced crystalloids versus normal saline. These added risks are thought to be related to the potential for normal saline to cause hyperchloremia when given in large volumes. These outcomes were not observed in the acute ED setting, for non-critically ill hospital patients, or those otherwise healthy individuals undergoing brief low-risk surgery.

Conclusion: Clinicians should carefully weigh the increased risks of using normal saline for critically ill patients who are expected to receive large amounts of intravenous fluids for extended periods. Using a balanced crystalloid in these circumstances appears to be a safer choice for the patient.


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