Intravenous Saline in Human Patients: A Detrimental Practice

Intravenous Saline in Human Patients: A Detrimental Practice

The Use of Intravenous Saline in Human Patients: A Detrimental Practice

Abstract

Intravenous (IV) saline solutions have been a mainstay in medical practice for decades, used for fluid resuscitation, electrolyte replacement, and other purposes. However, mounting evidence suggests that the use of IV saline, particularly 0.9% sodium chloride solution, may be harmful to patients. This paper examines the potential risks associated with IV saline use and argues that it should no longer be employed in human patients due to its deleterious effects on kidney function, acid-base balance, and overall patient outcomes.

Introduction

Intravenous saline solutions are commonly used in hospitals and clinical settings for a variety of purposes, including fluid resuscitation, electrolyte replacement, and medication delivery. The most widely used IV solution is 0.9% sodium chloride, also known as normal saline (NS). However, despite its widespread use, there is growing concern about the potential harmful effects of NS on human physiology and patient outcomes.

Kidney Function and Acid-Base Balance

One of the primary concerns with the use of NS is its impact on kidney function and acid-base balance. NS is a hypertonic solution, meaning it has a higher concentration of solutes than the body's extracellular fluid. When administered intravenously, NS can cause a disruption in the body's fluid balance, leading to hyperchloremic metabolic acidosis (HMA) (Yunos et al., 2012).

HMA is a condition characterized by an excess of chloride ions in the blood, which can lead to a decrease in blood pH and impaired kidney function (Goldstein et al., 2020). This condition has been associated with various adverse outcomes, including increased risk of acute kidney injury (AKI), prolonged hospital stays, and higher mortality rates (Yunos et al., 2012; Goldstein et al., 2020).

Moreover, the high chloride content in NS has been linked to inflammatory processes and endothelial dysfunction, which can exacerbate various conditions, such as sepsis and acute respiratory distress syndrome (ARDS) (Shao et al., 2020).

Alternative Solutions

In light of these concerns, several alternative IV solutions have been proposed and studied. One such alternative is balanced crystalloid solutions, such as Ringer's lactate or Plasma-Lyte, which have electrolyte compositions closer to that of human plasma (Semler et al., 2018).

Clinical trials have demonstrated that the use of balanced crystalloid solutions is associated with a lower risk of AKI, HMA, and other adverse outcomes compared to NS (Semler et al., 2018; Goldstein et al., 2020). Furthermore, balanced solutions have been shown to have beneficial effects on acid-base balance, hemodynamics, and overall patient outcomes (Shao et al., 2020).

Conclusion

Given the mounting evidence highlighting the potential risks associated with the use of intravenous saline, particularly 0.9% sodium chloride solution, it is clear that this practice should be reevaluated and potentially discontinued in human patients. The deleterious effects of NS on kidney function, acid-base balance, and overall patient outcomes cannot be ignored.

Instead, healthcare professionals should consider adopting alternative IV solutions, such as balanced crystalloid solutions, which have been shown to be safer and more physiologically appropriate. By making this shift, the medical community can improve patient care, reduce the risk of adverse events, and ultimately enhance patient outcomes.

References

Goldstein, S. L., Kirkendall, E., Nguyen, H., Schaffzin, J. K., Bucuvalas, J., Bracken, L., ... & Pediatric Acute Lung Injury and Sepsis Network (PALISI) (2020). Electronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics, 145(2).

Semler, M. W., Self, W. H., Wanderer, J. P., Ehrenfeld, J. M., Wang, L., Byrne, D. W., ... & Rice, T. W. (2018). Balanced crystalloids versus saline in critically ill adults. New England Journal of Medicine, 378(9), 829-839.

Shao, M., Li, G., Sarpong, K., Badawy, S., Deshmukh, S., Yan, Y., ... & Xue, J. (2020). Normal saline versus balanced crystalloids for fluid resuscitation in critically ill adults: A systematic review and meta-analysis. Journal of Clinical Anesthesia, 64, 109819.

Yunos, N. M., Bellomo, R., Hegarty, C., Story, D., Ho, L., & Bailey, M. (2012). Association kidney injury with restrictive versus liberal fluid therapy. Kidney International, 82(1), 47-54.
 

Related topics: advanced practice (7) | critical care (14) | hydration (4) | paramedic (12) | Physicians (9) | Resuscitation (8) | Saline (3)


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