What are the characteristics, adverse reactions, and dosages of colloid and crystalloid solutions in adults and pediatrics?

From the Guidelines

Crystalloid solutions, such as normal saline (0.9% NaCl) or lactated Ringer's solution, are recommended as the first-line treatment for fluid resuscitation in adults and children due to their lower risk of adverse reactions and comparable efficacy to colloid solutions. Crystalloid solutions include normal saline, which contains sodium and chloride ions and is isotonic with blood, dosed at 10-20 ml/kg in adults and children, with potential adverse reactions including hyperchloremic metabolic acidosis and fluid overload 1. Lactated Ringer's solution contains sodium, chloride, potassium, calcium, and lactate, and is given at similar doses, but should be used cautiously in liver disease patients due to lactate metabolism concerns.

Characteristics of Colloid Solutions

Colloid solutions include albumin (5% or 25%), typically dosed at 0.5-1 g/kg in adults and children, with potential adverse reactions including allergic reactions and hypotension. Hydroxyethyl starch (HES) solutions are dosed at 10-30 ml/kg but have significant adverse reaction risks including coagulopathy, renal dysfunction, and anaphylaxis, limiting their use in many clinical settings 1. Gelatins are given at 10-20 ml/kg but can cause allergic reactions and coagulation disturbances.

Adverse Reactions and Dosages

When selecting between crystalloids and colloids, consider that crystalloids require larger volumes for the same hemodynamic effect but have fewer serious adverse reactions, while colloids provide more sustained volume expansion but carry greater risks of adverse reactions and are more expensive. The most recent and highest quality study, published in 2022, recommends against the use of albumin as first-line treatment for sepsis or septic shock due to its lack of superiority over crystalloids in reducing mortality or renal replacement therapy requirement 1.

Key Considerations

• Crystalloids are recommended as the first-line treatment for fluid resuscitation in adults and children due to their lower risk of adverse reactions and comparable efficacy to colloid solutions.
• Colloid solutions, such as albumin and HES, carry greater risks of adverse reactions and are more expensive, but may be considered in specific situations, such as severe Dengue shock syndrome in children.
• The dosage and selection of fluid resuscitation solutions should be individualized based on the patient's condition, medical history, and response to treatment.
• It is essential to monitor patients closely for signs of fluid overload, allergic reactions, and other adverse effects when administering fluid resuscitation solutions.
• The use of dopamine or epinephrine (adrenaline) should be considered in patients with persistent tissue hypoperfusion despite liberal fluid resuscitation, and their use should be guided by frequent measurements of arterial blood pressure and heart rate 1.

From the Research

Characteristics of Colloid and Crystalloid Solutions

• Colloid solutions have larger molecules and are more expensive than crystalloid solutions, which have small molecules and are cheaper [ 2 ].
• Crystalloids provide immediate fluid resuscitation but may increase oedema, while colloids may provide swifter volume expansion in the intravascular space [ 2 ].
• Examples of colloids include starch solutions, dextrans, gelatins, and albumin or fresh frozen plasma (FFP) [ 2 ].

Adverse Reactions

• Colloids may induce allergic reactions, blood clotting disorders, and kidney failure [ 2 ].
• Starches probably slightly increase the need for blood transfusion and renal replacement therapy (RRT) [ 2 ].
• Dextrans, gelatins, and albumin or FFP may have uncertain effects on adverse events due to low-certainty evidence [ 2 ].

Dosages

• The optimal dosage of colloid and crystalloid solutions is not explicitly stated in the provided studies, but the choice of fluid and dosage may depend on the patient's condition and response to treatment [ 3 ].
• Crystalloids may require larger volumes to achieve the same hemodynamic effect as colloids [ 4 ].

Comparison of Colloids and Crystalloids in Adults and Pediatrics

• There is no evidence from randomized controlled trials that resuscitation with colloids reduces the risk of death compared to crystalloids in patients with trauma, burns, and following surgery [ 5 ].
• Crystalloids may be less efficient than colloids at stabilizing resuscitation endpoints, but may have a lower risk of adverse events [ 4 ].
• The choice of fluid may depend on the patient's condition, age, and underlying disease, as well as the clinician's preference and experience [ 6 ].