A balanced view of balanced solutions
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* Corresponding author: Bertrand Guidet bertrand.guidet@sat.aphp.fr
1 Inserm, Unité de Recherche en Épidémiologie Systèmes d'Information et Modélisation (U707), Paris F-75012, France
2 UPMC Université, Paris 06, 4 Place Jussieu, 75005 Paris, France
3 Medical ICU, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris F-75012, France
4 Intensive Care and Anaesthesia, Chelsea and Westminster Hospital, London SW10 9NH, UK
5 Imperial College London, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, South Kensington Campus, London SW7 2AZ, UK
6 Department of Anesthesia and Intensive Care Medicine, University Hospital, Medical School, University of Udine, P.le S. Maria della Misericordia, 1533100 Udine, Italy
7 Department of Anaesthesiology, General Intensive Care and Pain Management, Vienna Medical University, Waehringer Guertel 18-20, 1090 Vienna, Austria
8 Department of Anesthesiology and Critical Care Medicine, Pôle d'Anesthesie Reanimation, Hôpital Claude Huriez, rue Michel Polonoski, CHU Univ Nord de France, 59000 Lille, France
9 Critical Care Department, Service Reanimation Medicale, Hôpital Raymond Poincaré (Assistance Publique - Hôpitaux de Paris), Université de Versailles SQY, 104 bd Raymond Poincaré, 92 380 Garches, France
10 Department of Anaesthesia, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
Critical Care 2010, 14:325 doi:10.1186/cc9230
See related letter by Oremus, http://ccforum.com/content/15/1/404
Published: 21 October 2010Abstract
The present review of fluid therapy studies using balanced solutions versus isotonic saline fluids (both crystalloids and colloids) aims to address recent controversy in this topic. The change to the acid-base equilibrium based on fluid selection is described. Key terms such as dilutional-hyperchloraemic acidosis (correctly used instead of dilutional acidosis or hyperchloraemic metabolic acidosis to account for both the Henderson-Hasselbalch and Stewart equations), isotonic saline and balanced solutions are defined. The review concludes that dilutional-hyperchloraemic acidosis is a side effect, mainly observed after the administration of large volumes of isotonic saline as a crystalloid. Its effect is moderate and relatively transient, and is minimised by limiting crystalloid administration through the use of colloids (in any carrier). Convincing evidence for clinically relevant adverse effects of dilutional-hyperchloraemic acidosis on renal function, coagulation, blood loss, the need for transfusion, gastrointestinal function or mortality cannot be found. In view of the long-term use of isotonic saline either as a crystalloid or as a colloid carrier, the paucity of data documenting detrimental effects of dilutional-hyperchloraemic acidosis and the limited published information on the effects of balanced solutions on outcome, we cannot currently recommend changing fluid therapy to the use of a balanced colloid preparation.