Podcast 754: Balanced Fluids vs. Normal Saline, The Battle Continues - The Emergency Medical Minute

Podcast 754: Balanced Fluids vs. Normal Saline, The Battle Continues

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Normal saline is thought to interfere with renal function and cause an acidosis and balanced fluids (like lactated ringers) are a better option
  • The SALT-ED trial and SMART trial showed a small benefit with renal injury and need for dialysis using balanced fluid in critically ill patients
  • Recent multicenter RCT in Brazil evaluated balanced fluids versus normal saline and looked at 90-day mortality
  • Found no difference in 90-day mortality or secondary outcomes like renal function
  • PLUS trial is currently being done in Australia and New Zealand to further evaluate fluid choice
  • Larger trials don’t show a major difference at this point, keep an eye out for future trials


Semler MW, Wanderer JP, Ehrenfeld JM, et al. Balanced Crystalloids versus Saline in the Intensive Care Unit. The SALT Randomized Trial. Am J Respir Crit Care Med. 2017;195(10):1362-1372. doi:10.1164/rccm.201607-1345OC


Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584

Zampieri FG, Machado FR, Biondi RS, et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial [published online ahead of print, 2021 Aug 10]. JAMA. 2021;326(9):1-12. doi:10.1001/jama.2021.11684


Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD


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