Plasmalyte: Recommended Use for Intravenous Hydration and Electrolyte Balance
Balanced crystalloid solutions like Plasmalyte should be used as first-line fluid therapy for intravenous hydration and electrolyte balance in most clinical scenarios requiring fluid resuscitation, particularly in critically ill patients, due to their lower risk of adverse renal events and better acid-base balance compared to 0.9% NaCl. 1, 2
Composition and Characteristics of Plasmalyte
Plasmalyte is a balanced crystalloid solution with electrolyte composition closely resembling human plasma:
| Component | Plasmalyte | Plasma | Normal Saline |
|---|---|---|---|
| Na+ (mmol/L) | 140 | 142 | 154 |
| K+ (mmol/L) | 5 | 4 | 0 |
| Cl- (mmol/L) | 98 | 103 | 154 |
| Ca2+ (mmol/L) | 0 | 2.4 | 0 |
| Mg2+ (mmol/L) | 1 | 1 | 0 |
| Buffer | Acetate 27, Gluconate 23 | HCO3 27 | None |
| Osmolarity (mOsm/L) | 295 | 285 | 308 |
| pH | 6.5-7.5 | 7.4 | 5-6.5 |
Clinical Indications for Plasmalyte
Hemorrhagic Shock
- Preferred over 0.9% NaCl as first-line fluid therapy for volume resuscitation
- Associated with reduced risk of hyperchloremic metabolic acidosis and potentially lower incidence of acute kidney injury
- Target systolic BP 80-90 mmHg until bleeding is controlled (higher targets for patients with traumatic brain injury) 1, 2
Critical Illness
- Recommended for critically ill adults requiring IV fluid resuscitation
- Associated with lower rates of major adverse kidney events (composite of death, new renal replacement therapy, or persistent renal dysfunction) compared to saline 4
- Helps maintain better acid-base balance and prevents hyperchloremia 1, 5
Trauma Resuscitation
- Improves acid-base status and reduces hyperchloremia compared to normal saline
- Results in greater improvement in base excess 24 hours post-injury 6
Volume Depletion in Older Adults
- Isotonic balanced solutions like Plasmalyte are appropriate for older adults with volume depletion
- Can be administered intravenously when oral or enteral routes are not feasible 1
Advantages of Plasmalyte
- Physiologic Electrolyte Profile: Composition closely mimics human plasma 3, 5
- Reduced Hyperchloremia: Lower chloride content (98 mmol/L) compared to normal saline (154 mmol/L) 1
- Better Acid-Base Balance: Contains acetate and gluconate as buffers that convert to bicarbonate 3, 6
- Improved Renal Outcomes: Associated with lower rates of adverse kidney events in critically ill patients 4
- Better Correction of Base Deficit: More effective in correcting acidosis in trauma patients 6
Potential Limitations and Contraindications
- Presence of Potassium: Contains 5 mmol/L of potassium, which requires consideration in patients with severe hyperkalemia 1
- Magnesium Content: Contains magnesium, which may affect peripheral vascular resistance and heart rate 3
- Traumatic Brain Injury: Normal saline may be preferred in some cases of traumatic brain injury to maintain higher plasma osmolality and reduce risk of cerebral edema 2
- Fluid Overload Risk: Like all crystalloids, can lead to edema with excessive administration 3
Monitoring During Plasmalyte Administration
- Regular assessment of electrolyte levels, particularly sodium, potassium, and chloride
- Monitoring of acid-base status
- Assessment of fluid balance and clinical signs of adequate perfusion
- Evaluation of renal function 1, 2
Common Pitfalls to Avoid
- Excessive Administration: Can lead to fluid overload, edema, and worsening of intracranial pressure
- Ignoring Electrolyte Status: Regular monitoring of electrolytes is essential
- Inappropriate Use in Severe Hyperkalemia: Consider alternative fluids in patients with severe hyperkalemia
- Medication Incompatibilities: Be aware of potential incompatibilities with certain medications 2, 3
Plasmalyte represents an advancement in fluid therapy by providing a more physiologically balanced solution that minimizes the risk of iatrogenic acid-base and electrolyte disturbances commonly seen with normal saline, while effectively restoring intravascular volume and maintaining electrolyte balance.