There has a been a little flutter of activity in the #FOAMed world this week about two trials published in the NEJM on the subject of balanced fluids in the care of critically ill patients, and also on admitted patients in US hospitals. The debate about balanced fluids vs. saline is fairly long standing, the view here at St Emlyn’s has been that balanced fluids offer a more physiological approach to resuscitation and fluid replacement. There is also clear evidence that saline causes a hyperchloraemic acidosis and some limited evidence that it may increase the need for renal replacement therapy.

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