Crystalloids : pros and cons
4 regimen appropriate to the individual ’ s biochemistry and fluid balance can reduce the sodium and chloride load . A recent meta-analysis demonstrated that , compared with hydroxyethyl starches , patients who received crystalloids or albumin were less likely to require renal replacement therapies and transfusion with red blood cells and experienced fewer overall adverse events . 8
Range of formulations and volumes A range of different crystalloid solutions are available , mainly containing sodium chloride and / or dextrose in a range of different concentrations , the most commonly used solutions being detailed in Table 1 . Hartmann ’ s and Ringer ’ s lactate solutions are also available , both of which contain lactate as a bicarbonate precursor . These were developed to be more similar to plasma in their composition . Some solutions are also available with additional potassium , so that maintenance or replacement of potassium can also be achieved via the one infusion . Most solutions are also available in a range of different volumes , according to individual patient fluid requirements .
Wide compatibility Most crystalloid solutions are compatible with a range of intravenous drugs and sodium chloride 0.9 % and dextrose 5 % are often used as diluents and carrier solutions for their administration . Individual compatibility details should always be confirmed before administration . However , it is not recommended to administer blood
Table 1 : Composition of commonly used crystalloid solutions
Fluid |
Sodium ( mmol / L ) |
Potassium |
|
|
( mmol / L ) |
products via the same intravenous line as Hartmann ’ s or dextrose 5 % due to concerns over clotting and haemolysis . 9
No religious objections to use As crystalloids are not derived from either human or animal sources , there are no religious or moral objections associated with their use .
Can be used as replacement or maintenance fluids Crystalloids can be used as both replacement and maintenance fluids . Meta-analyses and
Chloride ( mmol / L )
Osmolarity ( mOsm / L )
Plasma 136 – 145 3.5 – 5.0 98 – 105 280 – 300 Dextrose 5 % 0 0 0 278
Dextrose 4 % saline 0.18 %
Sodium chloride 0.9 %
Sodium chloride 0.45 %
30 0 30 283
154 0 154 308
77 0 77 154
Ringer ’ s lactate 130 4 109 273 Hartmann ’ s 131 5 111 275
" Most crystalloid solutions are compatible with a range of intravenous drugs and sodium chloride 0.9 % and dextrose 5 % are often used as diluents and carrier solutions for their administration ”
systematic reviews have shown that crystalloids are effective in fluid resuscitation in septic and critically ill patients . 5 , 6 , 8 If used appropriately according to individual maintenance fluid requirements , crystalloid solutions can effectively maintain fluid and electrolyte balance . 4
However , it should be noted that crystalloids are not indicated for volume replacement in all clinical settings . According to recent recommendations of the Surviving Sepsis Campaign Guidelines and ESICM , the use of albumin is advocated for fluid resuscitation in patients www . hospitalpharmacyeurope . com