From the Guidelines
Running normal saline can be beneficial in certain cases of acute kidney injury (AKI), particularly when the AKI is caused by dehydration, hypovolemia, or prerenal causes, as it helps restore intravascular volume, improve renal perfusion, and enhance glomerular filtration rate, as suggested by the KDIGO guidelines 1. The typical approach involves intravenous administration of isotonic (0.9%) normal saline at rates determined by the patient's clinical status, usually starting at 10-20 ml/kg over 1-2 hours for initial resuscitation, followed by maintenance fluids as needed.
- The benefit of normal saline comes from its ability to restore intravascular volume, improve renal perfusion, and enhance glomerular filtration rate.
- However, fluid therapy must be carefully monitored as excessive fluid administration can worsen kidney function and lead to complications like pulmonary edema or heart failure.
- For patients with AKI, regular monitoring of urine output, vital signs, and electrolytes is essential during fluid administration.
- In cases of severe AKI, fluid overload, or electrolyte disturbances, normal saline may be insufficient, and other interventions like diuretics, renal replacement therapy, or specialized fluid formulations might be necessary.
- The decision to use normal saline should be individualized based on the underlying cause of AKI, the patient's volume status, and comorbidities, as recommended by the KDIGO guidelines 1. It is also important to note that the use of normal saline may induce a hyperchloraemic metabolic acidosis, especially with large volumes, which might complicate the course of critically ill patients, as mentioned in the study 1.
- Therefore, careful consideration and monitoring of the patient's condition are necessary when using normal saline for AKI treatment.
- Additionally, the KDIGO guidelines suggest using isotonic crystalloids rather than colloids as initial management for expansion of intravascular volume in patients at risk for AKI or with AKI 1.
From the Research
Fluid Management in AKI
- The use of fluid management in Acute Kidney Injury (AKI) is a topic of discussion, with some studies suggesting that early, rapid restoration of circulatory volume is beneficial, but should be limited after the first 24-48 hours to avoid volume overload 2.
- The choice of fluid, such as balanced crystalloid solutions versus normal saline, remains controversial 2.
Role of Normal Saline
- There is no direct evidence to suggest that running normal saline is beneficial for AKI treatment, but fluid management is crucial in preventing and managing AKI 2, 3.
- Normal saline may be used as part of fluid management, but its effectiveness in AKI treatment is not well established 2.
Alternative Treatment Options
- Loop diuretics, such as furosemide, may be used in certain situations to prevent AKI, but their effectiveness in treating established AKI is limited 4, 5, 6.
- Renal replacement therapy should only be started on the basis of hard criteria, but should not be delayed when criteria are met 2.
- Conservative management should first be attempted for patients with AKI, and if it fails, renal replacement therapy or hemodialysis can be used 3.