Articles  |   April 2019
SEE Question
Article Information
Critical Care / Renal and Urinary Systems / Electrolyte Balance / Articles
Articles   |   April 2019
SEE Question
ASA Monitor 4 2019, Vol.83, 52-53.
ASA Monitor 4 2019, Vol.83, 52-53.
A 70-year-old woman fell at home and fractured her hip. You are called to the emergency department (ED) to evaluate the patient for impending surgery. The orthopedic surgeon who called you is writing the admission orders, including normal saline as the intravenous (I.V.) fluid. A recent prospective, randomized study compared outcomes in patients admitted to non–intensive care unit (ICU) beds. Which of the following outcomes is most likely in patients receiving saline compared to patients receiving a more balanced salt solution such as lactated Ringer’s solution?
I.V. fluid administration has been a mainstay of hospital medicine since World War I. Fluids are given to prevent dehydration in patients unable to tolerate oral intake and as a carrier for I.V. medications. Despite their ubiquity in clinical practice, however, none of the commonly used I.V. fluids have been scientifically validated in the manner of a new medication or implantable device. The most commonly used fluid – 0.9 percent sodium chloride, or “normal saline” – is close to the composition of salt water, but is hyperosmotic, hypernatremic and highly hyperchloremic compared with human extracellular fluid. Volume administration of normal saline is known to produce a hyperchloremic metabolic acidosis that is harmful to critically ill patients or those undergoing major surgery.
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