The online version of this article (doi:10.1186/cc9230) contains supplementary material, which is available to authorized users.
BG has received honoraria and financial reimbursements from Fresenius Kabi for lecturing and authorship, and from Laboratoire Français du Fractionnement et des Biotechnologies for lecturing; he is the principal clinical trial investigator in the Effects of Voluven on Hemodynamics and Tolerability of Enteral Nutrition in Patients With Severe Sepsis (CRYSTMAS Trial), sponsored by Fresenius Kabi. NS has received honoraria and financial reimbursements from Fresenius Kabi; his nonfinancial competing interest pertains to adverse comments made about a set of guidelines relating to fluids, both in lectures and in text. GDR has received honoraria for attending a Fresenius Kabi advisory board meeting. SK has received honoraria for lecturing, and reimbursements for travel and hotel accommodation from Fresenius Kabi and B Braun. BV has received consulting fees and honoraria from B Braun, Baxter and Fresenius Kabi. DA has received honoraria for attending a Fresenius Kabi advisory board meeting. MJ has received honoraria for lectures from several fluid companies, particularly Fresenius Kabi; he was given an unrestricted educational grant from Fresenius Kabi for the First Randomised Controlled, Double-blind Study of Crystalloids vs Colloids in Trauma (FIRST Trial).
The present review of fluid therapy studies using balanced solutions versus isotonic saline fluids (both crystalloids and colloids) aims to address recent controversy in this topic. The change to the acid-base equilibrium based on fluid selection is described. Key terms such as dilutional-hyperchloraemic acidosis (correctly used instead of dilutional acidosis or hyperchloraemic metabolic acidosis to account for both the Henderson-Hasselbalch and Stewart equations), isotonic saline and balanced solutions are defined. The review concludes that dilutional-hyperchloraemic acidosis is a side effect, mainly observed after the administration of large volumes of isotonic saline as a crystalloid. Its effect is moderate and relatively transient, and is minimised by limiting crystalloid administration through the use of colloids (in any carrier). Convincing evidence for clinically relevant adverse effects of dilutional-hyperchloraemic acidosis on renal function, coagulation, blood loss, the need for transfusion, gastrointestinal function or mortality cannot be found. In view of the long-term use of isotonic saline either as a crystalloid or as a colloid carrier, the paucity of data documenting detrimental effects of dilutional-hyperchloraemic acidosis and the limited published information on the effects of balanced solutions on outcome, we cannot currently recommend changing fluid therapy to the use of a balanced colloid preparation.
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- A balanced view of balanced solutions
Giorgio Della Rocca
- BioMed Central
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