Saline May Not Be As Safe As Earlier Believed

Saline May Not Be As Safe As Earlier BelievedImage used is for illustration purpose only

Using a different intravenous fluid instead of the usual saline greatly reduced the risk of death or kidney damage, two large studies found. Some doctors are hoping the results will persuade more hospitals to switch.

Studies have found that the presently used concentration of saline leads to an increased risk of kidney damage and death and replacing them with an alternate fluid could reduce the deaths by 50,000 to 70,000 and reduce the number of kidney failures by 100,000 annually.

Hospitalized patients given IV balanced fluids instead of saline showed a roughly 1% decreased incidence of death and serious kidney injury, according to results of two studies that compared outcomes with the two widely used IV trauma therapies.

Saline IV fluids are one of the most commonly used medications in healthcare to prevent dehydration, flush wounds, deliver IV medications, maintain dialysis and chemotherapy and maintain the blood pressure of the patients.

Saline has a higher concentration of sodium and chloride (essentially table salt) than blood does, while the balanced solution has a much closer match to typical sodium and chloride levels in blood.

“We found that these balanced solutions tended to make people live longer and have less kidney damage,” said Dr. Wesley Self, a physician and researcher at Vanderbilt University Medical Center.

The improved outcomes suggest that largely replacing saline with balanced fluids in the hospital setting could result in significant mortality and morbidity reductions, said Matthew W. Semler, MD, of Vanderbilt University Medical Center in Nashville.

“Doctors have been giving patients IV fluids for over a hundred years and saline has been the most common fluid patients have been getting,” said study author Todd Rice, MD, MSc, associate professor of Medicine.

While the balanced solution is preferred for general treatment, saline may still be preferred for people with low sodium levels or with brain trauma.

Authors of new study on saline say a switch to so-called balanced fluids could save thousands of lives a year. Both types of fluids are similar in terms of costs and most manufacturers make both types. This means that the switch is inexpensive and easy.

The studies were presented at the Society of Critical Care Medicine (SCCM) annual meeting this week. The results were simultaneously published in the New England Journal of Medicine.

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