IV Fluid Formulations for ICU Patients
Intravenous Fluid Formulations and Chloride-Restrictive IV Fluids for ICU Patients
| Content per 1 L | Lactated Ringer's | Normal Saline (0.9%) | Plasma-Lyte 148 | D5W | D5 1/2NS | 5% albumin |
|---|---|---|---|---|---|---|
| Na (mEq) | 130 | 154 | 140 | 0 | 77 | 130-160 |
| K (mEq) | 4 | 0 | 5 | 0 | 0 | < 1 |
| Cl (mEq) | 109 | 154 | 98 | 0 | 77 | 130-160 |
| Ca (mEq) | 3 | 0 | 0 | 0 | 0 | 0 |
| Mg (mEq) | 0 | 0 | 3 | 0 | 0 | 0 |
| Lactate (mEq) | 28 | 0 | 0 | 0 | 0 | 0 |
| Acetate (mEq) | 0 | 0 | 27 | 0 | 0 | 0 |
| Gluconate (mEq) | 0 | 0 | 23 | 0 | 0 | 0 |
| Glucose (mg/dL) | 0 | 0 | 0 | 4545 | 4545 | 0 |
| Osmolarity (mOsm/L) | 273 | 308 | 294 | 252 | 406 | 309 |
| pH | 6.5 | 5.0 | 5.0 | 4.0 | 4.5 | 6.4-7.4 |
| Other | 0 | 0 | 0 | 0 0 | 50 g/L albumin |
- Design: Prospective open, label sequential study of 760 ICU patients (control) and 773 ICU patients (study group) at single hospital in Melbourne, Australia
- Control period: Standard IVF per physician preference
- Study period: Chloride-rich IVF (0.9% saline, 4% succinylated gelatin solution, 4% albumin) became restricted and required specialist approval. Standard fluids allowed were chloride-restrictive fluids (Hartmann solution – similar to Lactated Ringer’s, Plasma-Lyte 148, chloride-poor 20% albumin)
| | Control period (Chloride-liberal) | Study period (Chloride-restricted) | P value | Odds ratio for Cl-restrictive fluid use | | --- | -----: | ----------------------------------: | --------: | ---------------------------------------: | | Mean serum Cr increased in umol/L | 22.6 (0.26 mg/dL) | 14.8 (0.17 mg/dL) | 0.3 | | | Incidence of injury & failure class for "acute kidney injury" (RIFLE defn) | 14% | 8.4% | <0.001 | 0.52 | | Use of renal replacement therapy (RRT) | 10% | 6.3% | 0.005 | 0.52 |
Bottom line:
Chloride-rich IV fluids were associated with greater acute kidney injury and need for RRT in ICU patients, compared to chloride-restrictive IV fluids.
NOTE: There was, however, NO difference in mortality, hospital, ICU length of stay, or RRT after hospital discharge.
References
- Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012 Oct 17;308(15):1566-72. [PubMed]
