Controversies in fluid therapy: Type, dose and toxicity

Table 2 Summary of studies comparing isotonic saline to balanced crystalloid solutions

Study	Design	Population	Solutions	Outcome
McFarlane et al[59]	RCT	Elective hepatobiliary/pancreatic surgery	0.9% saline vs PL-148	Iatrogenic metabolic acidosis with 0.9% saline
Wilkes et al[47]	RCT	Major abdominal surgery	0.9% saline vs Hartmann's (in HES)	Iatrogenic metabolic acidosis with 0.9% saline
O'Malley et al[48]	RCT	Kidney transplant recipients	0.9% saline vs RL	Iatrogenic metabolic acidosis and hyperkalemia with 0.9% saline
Yunos et al[56]	Prospective before-and-after	Critically ill patients	Chloride-rich vs chloride-poor fluid strategy	More acidosis with chloride-rich; more alkalosis and reduced cost with chloride-poor
Chowdbury et al[26]	RCT (cross-over)	Healthy volunteers	0.9% saline vs PL-148 (2 L infusion)	↑Δ [Cl-]; ↑ Strong ion difference; ↓ RBF; ↑ weight gain; ↑ extravascular volume; ↑ time to micturation
Chua et al[49]	Retrospective	Critically ill with DKA	0.9% saline vs PL-148	More rapid resolution of acidosis with PL-148
Shaw et al[55]	Retrospective	Major abdominal surgery	0.9% saline vs PL-148	↑ Major infection; ↑ composite of complications; ↑ blood transfusions; and ↑ RRT with 0.9% saline
Yunos et al[57]	Prospective before-and-after	Critically ill patients	Chloride-rich vs chloride-poor fluid strategy	↑ AKI (KDIGO stage II/III); ↑ RRT with chloride-rich strategy

Adapted from Raghunathan et al[58]. RCT: Randomized clinical trial; 0.9% saline: Normal saline; PL: Plasmalyte; RL: Ringers lactate; RBF: Renal blood flow; DKA: Diabetic ketoacidosis; AKI: Acute kidney injury; HES: Hydroxyethyl starch; RRT: Renal replacement therapy; KDIGO: Kidney disease improving global outcomes; FO: Fluid overload; FB: Fluid balance.