Monday, June 9, 2014

There is something about 'Normal' Saline !!!

A 0.9% solution of saline is isotonic and is therefore called physiological or “normal.” The fluid contains a marked surplus of chloride ions and no buffer  and, hence, infusion of 2 liters or more of the fluid causes hyperchloremic metabolic acidosis. 

In adults, normal saline should be reserved for patients with hypochloremic metabolic alkalosis, as in disease states associated with vomiting. The fluid has a more accepted role for perioperative fluid therapy in children where the risk of subacute hyponatremia is a more serious concern than in adults.

When infused in healthy volunteers normal saline might cause abdominal pain, which is not the case for lactated Ringer’s. The fluid also has more undesired effects, including acidosis, when used during surgery.

 Normal saline is excreted more slowly than both lactated and acetated Ringer’s solution , increasing the volume effect (“efficiency”) of the fluid to be about 10% greater compared with the Ringer’s solutions.


Scheingraber S, Rehm M, Sehmisch C, Finisterer U. Rapid saline infusion produces hyperchloremic acidocis in patients undergoing gynecologic surgery. Anesthesiology 1999; 90: 1265–70.

Williams EL, Hildebrand KL, McCormick SA, Bedel MJ. The effect of intravenous lactated Ringer´s solution vs. 0.9% sodium

chloride solution on serum osmolality in human volunteers. Anesth Analg 1999; 88: 999–1003.

Wilkes NJ, Woolf R, Mutch M, et al. The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 2001; 93: 811–16.

Drobin D, Hahn RG. Kinetics of isotonic and hypertonic plasma volume expanders. Anesthesiology 2002; 96: 1371–80.

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