From the Guidelines
Normal Saline (NS) is more commonly used than Lactated Ringer's (LR) in hospital settings due to its simplicity, compatibility with most medications, and predictable electrolyte composition, despite recent evidence suggesting LR may be preferable in large-volume resuscitation to avoid hyperchloremic metabolic acidosis 1.
Key Points
- NS has historically been the standard intravenous fluid due to its compatibility with most medications and predictable electrolyte composition (0.9% sodium chloride) 1.
- Unlike LR, NS doesn't contain calcium, making it safer to administer with blood products and certain medications like ceftriaxone that can form precipitates with calcium.
- Recent studies, such as the SMART trial, have shown that balanced crystalloids like LR may result in improved patient outcomes and reduce morbidity and mortality compared to NS 1.
- The use of 0.9% saline should be limited, especially in higher-risk patients with existing electrolyte derangements such as acidosis or hyperchloremia and those who might require a significant amount of fluid resuscitation 1.
Clinical Considerations
- Patients undergoing emergency laparotomy are likely to experience electrolyte abnormalities, and correcting these disturbances is important to maintain body homeostasis 1.
- Electrolyte disturbances can lead to a variety of adverse events in the intraoperative and postoperative setting, including cardiac dysrhythmias, particularly atrial fibrillation 1.
- Existing guidelines and institutional protocols should be used to guide treatment, and patients should be appropriately monitored when significant electrolyte abnormalities are suspected 1.
From the Research
Comparison of Normal Saline and Lactated Ringer's Solution
- The choice between Normal Saline (NS) and Lactated Ringer's (LR) solution in a hospital setting depends on various factors, including the patient's condition and the type of procedure being performed 2, 3, 4, 5, 6.
- Studies have shown that NS and LR have similar effects on quality of recovery in stable emergency department patients 2.
- However, in cases of massive hemorrhage and resuscitation, LR may be superior to NS due to its ability to reduce acidosis and improve survival rates 3.
- In patients with sickle cell disease, LR has been shown to have a small but significant improvement in hospital-free days and secondary outcomes compared to NS 4.
- The use of NS versus LR can also affect coagulation and blood loss in uncontrolled hemorrhagic shock, with LR leading to greater hypercoagulability and less blood loss 5.
- In abdominal aortic aneurysm repair, the use of NS can result in hyperchloremic acidosis and require more bicarbonate therapy and blood products compared to LR 6.
Factors Influencing the Choice of Fluid
- The type and severity of the patient's condition, such as massive hemorrhage or sickle cell disease, can influence the choice of fluid 3, 4.
- The need for fluid resuscitation and the volume of fluid required can also impact the decision to use NS or LR 5, 6.
- The potential for acidosis and coagulation disorders should be considered when choosing between NS and LR 3, 5, 6.