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Crystalloids: pros and cons


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 4


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


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Table 1: Composition of commonly used crystalloid solutions Fluid


Sodium (mmol/L) Plasma Dextrose 5%


Dextrose 4% saline 0.18%


Sodium chloride 0.9%


Sodium chloride 0.45%


Ringer’s lactate Hartmann’s


136–145 0


30 154 77


130 131


Potassium (mmol/L)


3.5–5.0 0 0


0 0


4 5


Chloride (mmol/L)


98–105 0


30 154 77


109 111


Osmolarity (mOsm/L)


280–300 278 283


308 154


273 275


"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”


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


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


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