IV Fluid Formulations for ICU Patients

Author: Michelle Lin, MD
Updated: 1/3/2012

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 | 77 130-160
K (mEq) 4 | 5 | < 1
Cl (mEq) 109 154 98 | 77 130-160
Ca (mEq) 3 | |
Mg (mEq) | 3 |
Lactate (mEq) 28 | |
Acetate (mEq) | 27 |
Gluconate (mEq) | 23 |
Glucose (mg/dL) | | 4545 4545
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 | | | 50 g/L albumin

Yunos et al JAMA 2012 study:

  • 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]