More and more comments, articles and podcasts have been talking about the effects of using 0.9% saline as a resuscitative or maintenance fluid. Concerns seem to stem from it's acidifying effects (ie high chloride) or "for you quantitative acid base buffs" , the low strong ion difference. (low as in zero, that is). Another concern is the high levels of chloride in the distal tubular lumen of the nephron potentiating renal afferent artery constriction via tubuloglomerular feedback, decrease renal blood flow, possibly a contributing factor to AKI (acute kidney injury) in susceptable patients.....what do you think?
We've also been taught that 0.9% NaCl is the fluid of choice for hyperkalemia (in Addison's for example) but is it really? Since Addisonians are already hyponatremic, isn't the bigger concern a potential detrimental rapid rise in Na with significant volume resuscitation when using normal saline? Most of our balanced isotonic replacement crystalloids do have K+ but in minor amounts compared to the levels of the hyperkalemic patient. Just a thought.
What about 0.9% NaCl as the fluid of choice in hypercalcemia? Could one argue that it's is the increase in GFR from volume resuscitation with any isotonic replacement crystalloid that helps lower the calcium, not just normal saline? This concept will require a "deeper dive" than we have time for now (more to come)
You will also find that 0.9% NaCl is listed as the resuscitative fluid of choice for TBI (Traumatic Brain Injury). The logic behind this is that this fluid choice has the least free water and therefore is the least likely to contribute to cerebral edema (another topic for a deeper dive).
Over the next several months, we will look deeper into these recommendations, the evidence and expert opinion on the use of Normal Saline.
OH, and did you know you can learn so much from FOAVet?....asynchronous learning is the buzz word these days. Do you take advantage of all there is in the world of FOA goodness? And, best of all, you can learn when YOU are ready. Personally, I listen to a podcast every day on my way to work. How about you? If you have a fav podcast, please share it, Who knows, we may be podcast buddies, eh?