What is the ideal crystalloid?

Journal Article (Journal Article;Review)

PURPOSE OF REVIEW: We discuss the importance of the composition of intravenous crystalloid solutions. On the basis of current physiologic principles, evidence from basic science and clinical experiments, recent observational studies, and clinical trials, we conclude that the 'ideal crystalloid' depends on clinical context. We make recommendations on solutions that may be used during critical illness, major surgery, and certain clinical situations. RECENT FINDINGS: The routine use of solutions with a supraphysiologic chloride content and a low strong ion difference (SID), such as isotonic saline solution, may be associated with adverse outcomes, especially among critically ill patients. On the contrary, solutions with a physiologic chloride content and a 'balanced' electrolyte composition (SID closer to plasma) may improve the likelihood of survival. The distribution of different types of crystalloids across traditional 'body compartments' is a function of osmolality of the fluid infused relative to plasma, integrity of the glycocalyx, and the hemodynamic/'volume' state of the patient. During critical illness, the routine administration of colloids may offer no clinical benefits compared with the use of crystalloids. SUMMARY: Crystalloids, like other types of intravenous fluids, are drugs with important effects on clinical outcomes that may be mediated by osmolality, chloride content, and SID.

Full Text

Duke Authors

Cited Authors

  • Raghunathan, K; Nailer, P; Konoske, R

Published Date

  • August 2015

Published In

Volume / Issue

  • 21 / 4

Start / End Page

  • 309 - 314

PubMed ID

  • 26103144

Electronic International Standard Serial Number (EISSN)

  • 1531-7072

Digital Object Identifier (DOI)

  • 10.1097/MCC.0000000000000218


  • eng

Conference Location

  • United States