Balanced fluids such as lactate ringers have made it to the
medicine literature finally.
This week in Annals of Internal Medicine, a meta analysis showed that balanced fluids trumped normal saline in sepsis treatment. Normal saline, initially invented during the cholera epidemic has come a long way in medicine literature.
This week in Annals of Internal Medicine, a meta analysis showed that balanced fluids trumped normal saline in sepsis treatment. Normal saline, initially invented during the cholera epidemic has come a long way in medicine literature.
|
Solution
|
pH
|
Na+
|
Cl-
|
K+
|
Ca++
|
Lactate
|
Glucose
|
Osmolality
|
Other
|
|
0.9% normal saline
|
5.0
|
154
|
154
|
0
|
0
|
0
|
0
|
308
|
0
|
|
LR
|
6.5
|
130
|
109
|
4
|
3
|
28
|
0
|
275
|
0
|
A landmark trial in JAMA in 2012 showed that
chloride based fluids might not have that great of renal outcomes. Another one showed increased renal blood flow.
In addition, this year in Nephmadness 2014, balanced
solutions was a top match.
Yes we need a real study. The limitations in that JAMA trial are extensive:
ReplyDelete• It was not randomized just a before and after trial.
• It was not blinded.
• the authors changed the end-point between when they registered the trial with trials.gov and published.
These are all weaknesses of this trial, though the train on balanced solutions seems to be leaving the station, I think we deserve higher quality evidence.