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Translated title of the contribution: Abnormal saline's swan song

Paul W G Elbers, Jos Kooter, Niels van Regenmortel

Research output: Contribution to journalReview articleProfessional


We previously suggested that choosing balanced solutions over normal saline for fluid therapy might benefit patients. After all, administration of NaCl 0.9% invokes metabolic acidosis and hyperchloraemia which was linked to renal failure and mortality in retrospective studies. Two large randomized controlled clinical trials now confirm this signal. Both in intensive care patients and in the setting of emergency medicine, balanced solutions were shown to reduce the incidence of MAKE30, a composite end point of hospital mortality and indices of renal failure. In addition, predefined subgroup analysis revealed increased mortality for normal saline in intensive care patients with sepsis. Even though the effect size is small in both studies, this evidence against normal saline is hard to ignore, given the immense number of patients who receive NaCl 0.9% worldwide. Therefore, clinical medicine may shortly witness the quiet disappearance of normal saline.

Translated title of the contributionAbnormal saline's swan song
Original languageDutch
JournalNederlands Tijdschrift voor Geneeskunde
Publication statusPublished - 7 Jun 2018


  • Critical Care
  • Electrolytes/administration & dosage
  • Fluid Therapy/adverse effects
  • Hospital Mortality
  • Humans
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Ringer's Lactate/administration & dosage
  • Saline Solution/administration & dosage
  • Sepsis/therapy

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