Normal Saline and Plasma-Lyte Perform Comparably in the ICU

Resuscitation with normal saline commonly results in a hyperchloremic, metabolic acidosis. Based mostly on observational studies, concern has emerged that chloride-rich intravenous (IV) fluids, such as normal saline, might cause acute kidney injury and worsen patient outcomes.

Four intensive care units (ICUs) in New Zealand followed specific fluid resuscitation protocols for four 7-week blocks, with randomization of the starting fluid (normal saline or Plasma-Lyte 148, a buffered IV fluid with 98 mEq of chloride). During each subsequent time block, ICUs alternated which blinded fluid was delivered to new patients. A total of 2092 patients received fluids; median volume was 2 L in both groups. Patients with renal failure and those expected to…