Normal Saline vs Balanced Fluids — What Does Recent Literature Say?

Intravenous fluid therapy, a crucial life-saving intervention for critically ill patients, raises questions about the optimal type, dose, and timing. Patient outcomes can be affected by the choice of resuscitation fluids, but only in the past 5-7 years has more attention been given to crystalloid therapy, specifically the differences between 0.9% saline and 'balanced' solutions.

Originating from the 1831 cholera pandemic, normal saline has been widely used, but recent concerns highlight its potential complications due to its high chloride concentration. Balanced crystalloids, such as lactated Ringer's and Plasma-Lyte, offer an alternative with electrolyte content closer to extracellular fluid.

While intravenous fluids are commonly used, an ideal fluid is yet to be found. Guidelines recommend crystalloids over colloids, but lack specificity on the type of crystalloid. Recent evidence prompts reevaluation of crystalloid choices in critical care. In my presentation, In this presentation, Dr. Islam will examine current research to determine the strength and conclusiveness of the evidence.

Dr. Tasbirul Islam is American Board Certified in Internal Medicine, Pulmonary, Critical Care, and Neuro-critical Care Medicine. He serves as a Clinical Associate Professor of Medicine at Indiana University School of Medicine, Medical Director for the Division of Pulmonary and Critical Care Medicine, Pulmonary & Critical Care Medicine Course Director for medical students, and Chairman of Planetary Health Academia (PHA).

He graduated from Dhaka Medical College in 1992 and completed an internal medicine residency in 2005 and a pulmonary & critical care medicine fellowship in 2008. He earned membership in the Royal College of Physicians of the UK after passing the MRCP examination in 1997. He was elected the best resident for three consecutive years and received the Golden Apple/Stethoscope Award for teaching excellence at Drexel University College of Medicine. In 2010 and 2022, he was voted the best teaching attending by residents and medical students. Dr. Islam has established an observership program for foreign medical graduates at his hospital since 2013. He has published over 20 papers in peer-reviewed journals.

The ICU REACH Team