0.9% saline is neither normal nor physiological
The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline (henceforth: saline) and to discuss the impact of saline infusion, specifically on systemic acid base balance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large volume >2 L) saline infusion in healthy adults induces hyperchloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload (80 ml/kg) in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium proton exchanger (NHE) and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemodynamics. Microperfusion experiments and real time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising O2 delivery to the renal parenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, increases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastrointestinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline related effects and adequate electrolyte management is needed.Zhong Wen Gai Yao Gai Yao Ben Wen Zhi Zai Ke Guan Ping Jie 0.9%Lu Hua Na Rong Ye (Yan Shui )De Sheng Wu Hua Xue He Bing Li Sheng Li Xue Te Xing ,Bing Shen Ru Tan Tao Jing Mai Shu Zhu Gai Yan Shui Dui Ji Ti Suan Jian Ping Heng He Shen Zang Xie Liu Dong Li Xue De Ying Xiang Yan Jiu Biao Ming Duo Shu Lin Chuang Yi Sheng Dui Dian Jie Zhi Ping Heng De Ren Shi You Xian ,Dui Jing Mai Shu Zhu Yan Shui Suo Yin Qi De Xie Jiang Dian Jie Zhi Bian Hua Ren Shi Bu Zu Er Cuo Wu Di Ying Yong Yan Shui Hui Zeng Jia Huan Zhe De Huan Bing Lu He Si Wang Lu Jian Kang Cheng Ren Da Ji Liang >2 L)Shu Zhu Yan Shui Hui Dao Zhi Gao Lu Xie Zheng Bing Jin Er Yin Qi Dai Xie Xing Suan Zhong Du Gao Jia Xie Zheng He Fu Dan Ping Heng Zong Zhi ,Yan Shui Shi Yi Chong Gao Du Suan Hua De Ye Ti ,Yong Yu Zhi Liao Ou Tu Huo Shang Xiao Hua Dao Jian Ya Yin Qi De Di Lu Xing Dai Xie Xing Jian Zhong Du He Rong Liang Bu Zu Jiao Wei He Gua Lin Chuang Shang Bu Jia Qu Fen Di Ying Yong Yan Shui Dui Huan Zhe Te Bie Shi Dui Zhong Zheng Huan Zhe Ke Neng Dao Zhi Bu Bi Yao De Bing Fa Zheng ,Ying Zhu Yi Bi Mian Lin Chuang Yi Sheng Dui Yu Yan Shui Xiang Guan Zuo Yong He Dian Jie Zhi Guan Li De Ren Shi Ji Xu Zeng Qiang
Journal of Zhejiang University SCIENCE B