The ideal crystalloid - what is 'balanced'?

Morgan, Thomas J. (2013) The ideal crystalloid - what is 'balanced'?. Current Opinion in Critical Care, 19 4: 299-307. doi:10.1097/MCC.0b013e3283632d46

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Author Morgan, Thomas J.
Title The ideal crystalloid - what is 'balanced'?
Journal name Current Opinion in Critical Care   Check publisher's open access policy
ISSN 1070-5295
Publication date 2013-08-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/MCC.0b013e3283632d46
Volume 19
Issue 4
Start page 299
End page 307
Total pages 9
Place of publication Philadelphia, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Purpose of Review:
This review explores the contemporary definition of the term 'balanced crystalloid' and outlines optimal design features and their underlying rationale.

Recent Findings:
Crystalloid interstitial expansion is unavoidable, but also occurs with colloids when there is endothelial glycocalyx dysfunction. Reduced chloride exposure may lessen kidney dysfunction and injury with a possible mortality benefit. Exact balance from an acid-base perspective is achieved with a crystalloid strong ion difference of 24  mEq/l. This can be done simply by replacing 24 mEq/l of chloride in 0.9% sodium chloride with bicarbonate or organic anion bicarbonate substitutes. Potassium, calcium and magnesium additives are probably unnecessary. Large volumes of mildly hypotonic crystalloids such as lactated Ringer's solution reduce extracellular tonicity in volunteers and increase intracranial pressure in nonbrain-injured experimental animals. A total cation concentration of 154 mmol/l with accompanying anions provides isotonicity. Of the commercial crystalloids, Ringer's acetate solution is close to balanced from both acid-base and tonicity perspectives, and there is little current evidence of acetate toxicity in the context of volume loading, in contrast to renal replacement.

Summary: The case for balanced crystalloids is growing but unproven. A large randomized controlled trial of balanced crystalloids versus 0.9% sodium chloride is the next step.
Keyword Acid-base
Balanced crystalloid
Strong ion difference
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
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Citation counts: TR Web of Science Citation Count  Cited 25 times in Thomson Reuters Web of Science Article | Citations
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