SEVERE WX : Winter Weather Advisory View Alerts
STREAMING NOW: Watch Now

Switching IV fluids could save thousands of lives, researchers say

Replacing the saline in many IV bags with another solution could save lives, according to two studies published Tuesd...

Posted: Mar 1, 2018 8:06 AM
Updated: Mar 1, 2018 8:06 AM

Replacing the saline in many IV bags with another solution could save lives, according to two studies published Tuesday in the New England Journal of Medicine.

The sister studies -- one on patients in the intensive care unit and one on adults who were not critically ill -- showed that "balanced crystalloids," solutions that are more similar to what's in human blood, were less likely to result in major kidney problems in the month after they were enrolled in the study.

Saline is commonly given through an IV to replenish fluids in the hospital

Studies showed that saline was linked to worse outcomes than another common IV fluid

ICU patients on these fluids in the hospital also died at lower rates within the 30 days. The study authors said that making the switch could save tens of thousands of lives among the millions who get these fluids in the hospital every year.

"Saline has been used in practice for over a century," said study author Dr. Todd W. Rice, director of the medical intensive care unit at Vanderbilt University Medical Center and an associate professor of medicine in its Division of Allergy, Pulmonary, and Critical Care Medicine.

"We actually heard from a number of people that there couldn't have been much difference between these two (intravenous fluids), because we would have already known it if there was."

Of nearly 16,000 critically ill patients, 10.3% of those given balanced crystalloids and 11.1% of those given saline died in the hospital within a month. Serious kidney events arose in 14.3% of the "balanced" group and 15.4% in the saline group.

On the other hand, the study of more than 13,000 patients who were not critically ill found that there was no difference in how early surviving patients were discharged in the four weeks after they came to the emergency room. But the researchers did find a slightly lower incidence of serious kidney events: 4.7% for the "balanced" group versus 5.6% for those receiving saline. This means 111 saline patients would need to be treated with balanced crystalloids instead in order to prevent one adverse kidney event.

Though these numbers may be substantial when looking at the country as a whole, Rice said it's not a reason to worry for an individual who finds themselves attached to a saline drip.

"For any one patient, the risk is pretty small," he said.

IV bags can contain any number of ingredients, such as fluids, sugars and medications. But many patients are dehydrated, and that's where saline and "lactated ringers," the most common balanced crystalloid, come in handy.

"We've tried to do a lot of history-looking to figure out why saline became the default," Rice said. "It's not entirely clear."

Neither IV fluid tends to cost more than the other, and both have been widely available for decades, the researchers said.

These fluids are meant to mirror salt concentrations in human blood, keeping water where it needs to be in order to better hydrate the body, according to Rice. (This is partly why chicken soup is often recommended for those who are sick, experts say.)

Saline consists of sodium chloride -- the main ingredient in common table salt -- dissolved in water. Lactated ringers contain several additional ions, such as calcium and potassium.

Research has suggested that a higher chloride concentration in saline can affect kidney function and lead to metabolic problems. However, a couple of smaller studies recently failed to show a difference between the two fluids, Rice said.

"This study makes me think again about what choice of fluids I'll use now," said Dr. David Hager, associate director of the medical ICU at the Johns Hopkins Hospital. Hager was not involved in the new studies.

Hager said he believes that other studies will spin off from this research, which was conducted at a single medical center. He also noted that the research was unblinded, meaning that doctors "knew they were giving one fluid versus another, and that may have an impact on other decisions that they make."

Patients who were not critically ill -- who received IV fluids in the emergency room -- did not necessarily receive the same fluid after being admitted to the hospital, the researchers said.

"That was actually quite a surprise to us," Rice said, and this could be because some patients receive the majority of these IV fluids in the emergency department.

It could also have something to do with being more vulnerable in the early stages of an illness, he said.

Doctors may still opt for saline if, for example, a patient has low concentrations of sodium or chloride, Rice said. Many of his colleagues who treat brain injuries are also wary of using lactated ringers over saline because of its potential impact on the pressure within the skull, he added.

"They get very very worried about increased swelling," Rice said. More research could uncover which types of patients are most sensitive to the effect of one fluid over another, he said.

Though Vanderbilt's hospital system has made changes to prioritize the balanced crystalloid, Rice said it could be a long time before this becomes standard practice.

"Change is slow in medicine -- slower than any of us believe it should be," he said. "We're trying to get the message out."

Minnesota Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 124439

Reported Deaths: 2292
CountyConfirmedDeaths
Hennepin32336965
Ramsey13342347
Dakota9251133
Anoka8093148
Stearns537035
Washington525967
Scott318534
Olmsted307029
St. Louis264763
Wright227614
Nobles214016
Clay203243
Blue Earth19707
Carver16957
Rice15789
Sherburne156221
Kandiyohi15494
Mower148912
Winona118918
Lyon9256
Waseca9129
Crow Wing87921
Chisago8552
Benton8415
Beltrami7687
Otter Tail7436
Todd7232
Steele7212
Itasca67617
Nicollet67317
Freeborn6324
Morrison6076
Douglas6043
Martin58616
Le Sueur5855
McLeod5703
Watonwan5674
Goodhue51111
Pine5090
Polk4924
Becker4893
Isanti4873
Chippewa3793
Carlton3781
Dodge3620
Mille Lacs3528
Pipestone32616
Wabasha3230
Cass3115
Hubbard3092
Meeker3073
Brown2983
Rock2971
Unassigned26553
Yellow Medicine2655
Cottonwood2620
Redwood25011
Murray2483
Fillmore2380
Sibley2383
Renville22911
Faribault2090
Jackson1951
Roseau1930
Swift1921
Wadena1880
Kanabec18610
Houston1811
Stevens1681
Lincoln1650
Pennington1631
Koochiching1624
Aitkin1542
Pope1480
Big Stone1270
Wilkin1244
Lac qui Parle1232
Lake1030
Mahnomen941
Norman940
Grant894
Marshall871
Clearwater760
Red Lake602
Traverse530
Lake of the Woods421
Kittson270
Cook110

Iowa Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 107481

Reported Deaths: 1537
CountyConfirmedDeaths
Polk17984282
Woodbury682088
Johnson563830
Black Hawk519196
Linn5047126
Dubuque467952
Scott404134
Story385317
Dallas329143
Pottawattamie295644
Sioux229712
Buena Vista220012
Marshall192636
Webster170014
Plymouth153925
Wapello147162
Clinton135525
Muscatine133958
Crawford130912
Cerro Gordo124923
Des Moines12139
Warren11496
Carroll10288
Jasper102034
Henry9785
Marion92410
Tama90037
Lee8719
Wright6871
Dickinson6847
Delaware6798
Boone6778
Mahaska61422
Bremer6128
Washington61011
Harrison5768
Jackson5283
Lyon5147
Benton5031
Louisa49115
Clay4844
Hamilton4433
Winnebago43716
Winneshiek4339
Hardin4285
Poweshiek42811
Kossuth4220
Floyd41511
Jones4113
Emmet39914
Buchanan3933
Cedar3855
Iowa3776
Franklin37318
Guthrie36914
Cherokee3652
Sac3643
Clayton3503
Page3470
Butler3442
Shelby3441
Madison3432
Fayette3412
Mills3361
Allamakee3278
Chickasaw3221
Clarke3123
Cass3052
Humboldt2913
Palo Alto2861
Hancock2814
Grundy2804
Calhoun2644
Osceola2480
Howard2479
Monroe23811
Mitchell2300
Monona2281
Taylor2202
Pocahontas2092
Union2094
Appanoose2013
Jefferson1901
Lucas1866
Fremont1781
Ida1772
Greene1730
Van Buren1572
Davis1554
Montgomery1555
Keokuk1401
Adair1331
Audubon1291
Decatur1290
Worth1270
Wayne1123
Ringgold822
Adams670
Unassigned190
Rochester
Overcast
29° wxIcon
Hi: 36° Lo: 30°
Feels Like: 21°
Mason City
Overcast
33° wxIcon
Hi: 41° Lo: 31°
Feels Like: 25°
Albert Lea
Overcast
34° wxIcon
Hi: 38° Lo: 30°
Feels Like: 28°
Austin
Overcast
34° wxIcon
Hi: 38° Lo: 31°
Feels Like: 27°
Charles City
Overcast
34° wxIcon
Hi: 42° Lo: 31°
Feels Like: 26°
Tracking a snow system moving through on Tuesday
KIMT Radar
KIMT Eye in the sky

Latest Video

Image

Rochester Postpones Fee Increase for Downtown Properties

Image

Rochester City Council approves updated DMC plan

Image

City Stops Fee Increase for Downtown Rochester

Image

DMC 5 YEAR PLAN APPROVED

Image

Terry Branstad visits old stomping grounds

Image

Sara's 10pm Forecast - Monday

Image

GOP fundraiser in Clear Lake

Image

Section soccer highlights and scores from Monday

Image

RPS wants help with name of new school

Image

Rochester City Council approves updated DMC plan

Community Events