Two very similar* animal studies show that in the setting of acute hemorrhage, less ringer’s lactate than 0,9 % saline is required to achieve a target mean arterial pressure. (1,2)

One human RCT demonstrated that, compared to ringer’s lactate, saline fluid replacement during aortic aneuvrysm repair is associated with larger needs of blood products, but had no effect on  intensive care or hospital stay, nor on complications rates. (3)  Yet another RCT concludes that in patients undergoing abdominal surgery, both fluids resulted in similar levels of mild coagulopathy and no difference in blood loss. Normal anion gap dilutional/hyperchloremic acidosis** occured only in patients repleted with saline, however. (4)

There is no proven adverse consequences to hyperchloremic acidosis and, as such, current evidence does not permit, in my opinion, to favor any one of the usual resuscitation fluids over the other.

* I seriously wonder if this similarity explains the failure of the later paper’s authors to acknowledge the work of their predecessors.

** To my best knowledge, whether acidosis occurs due to the addition of chloride anions or to the dilution of bicarbonate buffers is far from being established. See Anesthesiology. 87(4):1009-1014 for a lovely discussion of possible mecanisms.

1. Kiraly LN, Differding JA, Enomoto TM, et al. Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. J Trauma. 2006;61(1):57-64

2.  Todd SR, Malinoski D, Muller PJ, Schreiber MA. Lactated Ringer’s is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock. J Trauma. 2007;62(3):636-9

3. Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR. Normal saline versus lactated Ringer’s solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg. 2001 Oct;93(4):817-22

4. Boldt J, Haisch G, Suttner S, Kumle B, Schellhase F. Are Lactated Ringer’s Solution and Normal Saline Solution Equal with Regard to Coagulation? Anesth Analg 2002;94:378–84