Examples of Balanced Crystalloids
The most commonly used balanced crystalloids are Ringer's Lactate (also called Lactated Ringer's) and Plasmalyte, both of which have electrolyte compositions closer to plasma than normal saline. [@1,2,3,4@]
Specific Balanced Crystalloid Solutions
The evidence identifies several balanced crystalloid solutions used in clinical practice:
Primary Options
- Ringer's Lactate (Lactated Ringer's) - Most widely studied and used balanced crystalloid [@1,2,3,4@]
- Plasmalyte - Alternative balanced solution with slightly different composition [@1,2,3,4@]
Additional Balanced Solutions
Other balanced crystalloids mentioned in the literature include:
- Ringer's Acetate - Considered close to ideal balance from both acid-base and tonicity perspectives 1
- Hartmann's solution - Similar to Ringer's Lactate 2
- Sterofundin 2
- Ringerfundin 2
- Normosol 2
Key Distinguishing Features
Balanced crystalloids differ from normal saline (0.9% NaCl) by having:
- Lower chloride content (closer to physiological levels)
- Sodium, potassium, and chloride concentrations more similar to extracellular fluid 3
- Buffering agents (lactate, acetate, or gluconate) that prevent hyperchloremic metabolic acidosis [@7,10@]
Clinical Advantages
The 2022 guidelines recommend balanced crystalloids over normal saline because they:
- Prevent hyperchloremic metabolic acidosis [@1,2,3,4@]
- May reduce adverse kidney events, particularly with high-volume resuscitation (>5000 mL) [@1,2,3,4@]
- Maintain better acid-base balance [@1,4@]
- Show potential mortality benefit in critically ill patients [@1,2,3,4@]
Plasmalyte vs Other Balanced Crystalloids
When comparing different balanced crystalloids, Plasmalyte results in lower serum chloride and lactate levels and higher base excess compared to other balanced solutions 2, though the clinical significance of these differences remains uncertain.
Practical Recommendation
Use either Ringer's Lactate or Plasmalyte as your default balanced crystalloid - both are widely available and supported by guideline recommendations [@1,2,3,4,5@]. The choice between them is less critical than the choice to avoid normal saline, particularly when administering large volumes or in patients at risk for acute kidney injury.