A recent New England Journal of Medicine reports two pragmatic cluster-randomised trials conducted at Vanderbilt UMC , Nasville, comparing normal saline versus balanced salt solution (Hartman’s.) In critical care patients, there was a difference in both length of hospital stay and other outcomes such as acute kidney injury. In non-critical care patients, there was no difference in hospital length of stay or mortality; however there was a difference in AKI rates. There is an accompanying editorial by Australia’s John Myburgh, although he focuses more on the outcomes used in the trial.  These results are consistent with the results of Rinaldo Bellomo, David Story, and coworkers at the Austin Hospital in Melbourne 2012. More evidence that ‘normal saline’ is anything but ‘normal’.

(On the topic of fluids:- Just as there have been recurrent drug shortages arising from supply issues, there have been shortages of supply of intravenous saline in the USA.)

Guidelines

 

Background/Reference Materials 

• Saline shortage NEJM April 19 2018
• Fluids Crit Care NEJM March 2018
• Fluids EDwards NEJM March 2018

Discussion Notes

 

 

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