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Critical care clinicians have long debated the best choice of intravenous fluid. In recent years, concern has risen about hyperchloremia and non–gap metabolic acidosis associated with use of normal saline.
In a secondary analysis of a previously published trial in which normal saline was compared with balanced crystalloid solutions among more than 15,000 patients in a single U.S. medical intensive care unit, investigators examined ≈1600 patients with sepsis. The primary analysis had demonstrated that balanced crystalloid use was associated with a slightly lower incidence of a composite outcome of mortality and renal failure when all critically ill patients — not just septic patients — were included (NEJM JW Gen Med Apr 15 2018 and N Engl J M…