For Most Patients Balanced IV Fluids Better Than Saline Interview with:

Wesley H. Self, MD, MPH Associate Professor Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN 

Dr. Self

Wesley H. Self, MD, MPH
Associate Professor
Department of Emergency Medicine
Vanderbilt University Medical Center
Nashville, TN What is the background for this study? What are the main findings? 

Response: Doctors have been giving IV fluids to patients for more than 100 years. The most common IV fluid during this time has been saline; it has high levels of sodium and chloride in it (similar to table salt).  Balanced fluids are an alternative type of IV fluid that has lower levels of sodium and chloride that are more similar to human blood.

Our studies were designed to see if treating patients with these balanced fluids resulted in better outcomes than saline.  We found that patients treated with balanced fluids had lower rates of death and kidney damage than patients treated with saline. What should readers take away from your report? 

Response: These result suggest that there may be a better way to treat patients with IV fluids than the most common way doctors have been doing it for the last century. Treating patients with IV fluids that are more similar in composition to blood appears to help save lives and prevent kidney damage. The risk of death or kidney damage for each patient is not very different for the two fluid types (about a 1% difference); but because so many people get IV fluids (millions each year), changing the type of fluid from saline to balanced fluids could help thousands and thousands of patients. What recommendations do you have for future research as a result of this work? 

Response: For most patients, it appears balanced fluids are better than saline. But there may be small groups of specific patients who are still be better off with saline.  Future studies will look into whether patients with certain injuries or illness are better off with saline.

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Balanced Crystalloids versus Saline in Noncritically Ill Adults

Wesley H. Self, M.D., M.P.H., Matthew W. Semler, M.D., Jonathan P. Wanderer, M.D.,
Li Wang, M.S., Daniel W. Byrne, M.S., Sean P. Collins, M.D.,
Corey M. Slovis, M.D., Christopher J. Lindsell, Ph.D., Jesse M. Ehrenfeld, M.D., M.P.H.,
Edward D. Siew, M.D., Andrew D. Shaw, M.B., Gordon R. Bernard, M.D.,  for the SALT-ED Investigators*
March 1, 2018
N Engl J Med 2018; 378:819-828
DOI: 10.1056/NEJMoa1711586

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Last Updated on March 1, 2018 by Marie Benz MD FAAD