CRYSTALLOIDS

Education of the entire multi-disciplinary team regarding the appropriate use of crystalloids within a balanced fluid regimen is essential to ensure that practice is consistent and informed by consensus guidelines

Nicola Ward DPharm MRPharmS Senior Lecturer in Clinical Pharmacy and Pharmacy Practice , Leicester School of Pharmacy , De Montfort University , Leicester , UK

Crystalloids are solutions made from low molecular weight salts or sugars that can pass between the intravascular and interstitial compartments . They are the most widely utilised intravenous solutions in hospitals , with the majority of surgical in-patients and many medical patients receiving at least one intravenous crystalloid infusion during their hospital admission . They were first used , in the form of intravenous salt solutions , in the early 19th century for the treatment of dehydration due to cholera , and were then first administered to surgical patients in the late 19th century . ¹ They are utilised for both fluid and electrolyte maintenance and replacement . Crystalloids are often perceived to be innocuous , low-risk intravenous solutions , with junior doctors often being responsible for their prescribing , despite them acknowledging a lack of expertise in fluid management . ² This lack of knowledge and training in fluid and electrolyte management was highlighted in the 1999 National Confidential Enquiry into Perioperative Deaths in the UK as contributing to perioperative morbidity and mortality . ³ This led to the development of national consensus guidelines to facilitate a consistent , evidence-based approach to crystalloid prescribing as a component of effective fluid management . ⁴ There is an ongoing debate regarding the comparative effectiveness and adverse effects of crystalloids versus colloids for specific clinical indications . This article will not examine these issues in great detail but instead aims to provide a brief overview of the main pros and cons of crystalloid solutions .

Pros Inexpensive Crystalloid solutions have lower acquisition costs compared with colloids . ⁵ In addition , a cost-effectiveness analysis performed in 1991 regarding the use of colloids and crystalloids in fluid resuscitation also illustrated that the cost of each life saved using crystalloids was $ 45.13 compared to $ 1493.60 with colloids . ⁶

Easy to store and long shelf life Crystalloid solutions are stable at room temperature , and so can easily be stored in a range of clinical settings , both in the hospital and in more challenging environments , such as field hospitals in combat settings , emergency ambulances or remote medical outposts . A long shelf life facilitates responsive stock management .

Readily available Crystalloid solutions are readily obtained within clinical settings , with the majority of clinical areas within an acute care environment maintaining stock of a range of appropriate crystalloids .

Low incidence of adverse events There is a low incidence of adverse reactions associated with crystalloid solutions . The main problems associated with the use of crystalloids are not immunologically-mediated reactions but are due to the prolonged administration of supraphysiological amounts of sodium and chloride , which can result in hyperchloraemic acidosis and

TABLE 1

Composition of commonly used crystalloid solutions

Fluid Sodium ( mmol / l ) Potassium ( mmol / l ) Chloride ( mmol / l ) Osmolarity ( mOsm / l )

Plasma 136 – 145 3.5 – 5.0 98 – 105 280 – 300

Dextrose 5 % 0 0 0 278

Sodium chloride 0.9 % 154 0 154 308

Sodium chloride 0.45 % 77 0 77 154

Ringer ’ s lactate 130 4 109 273

Hartmann ’ s 131 5 111 275

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