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CLC number: R692

On-line Access: 2016-03-07

Received: 2015-08-26

Revision Accepted: 2016-01-03

Crosschecked: 2016-02-15

Cited: 2

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Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Qi Qian

http://orcid.org/0000-0002-1735-2657

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Journal of Zhejiang University SCIENCE B 2016 Vol.17 No.3 P.181-187

http://doi.org/10.1631/jzus.B1500201


0.9% saline is neither normal nor physiological


Author(s):  Heng Li, Shi-ren Sun, John Q. Yap, Jiang-hua Chen, Qi Qian

Affiliation(s):  Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; more

Corresponding email(s):   Qian.Qi@mayo.edu

Key Words:  0.9% saline, Hyperchloremia, Acidosis, Hyperkalemia, Balanced fluids, Renal hemodynamics


Heng Li, Shi-ren Sun, John Q. Yap, Jiang-hua Chen, Qi Qian. 0.9% saline is neither normal nor physiological[J]. Journal of Zhejiang University Science B, 2016, 17(3): 181-187.

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Abstract: 
The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline (henceforth: saline) and to discuss the impact of saline infusion, specifically on systemic acid-base balance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume (>2 L) saline infusion in healthy adults induces hyperchloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload (80 ml/kg) in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger (NHE) and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemodynamics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising O2 delivery to the renal parenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, increases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastrointestinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.

0.9%盐水既不正常也不生理

概要:本文旨在客观评价0.9%氯化钠溶液(盐水)的生物化学和病理生理学特性,并深入探讨静脉输注该盐水对机体酸碱平衡和肾脏血流动力学的影响。研究表明多数临床医生对电解质平衡的认识有限,对静脉输注盐水所引起的血浆电解质变化认识不足。而错误地应用盐水会增加患者的患病率和死亡率。健康成人大剂量(>2 L)输注盐水会导致高氯血症并进而引起代谢性酸中毒、高钾血症和负氮平衡。总之,盐水是一种高度酸化的液体,用于治疗呕吐或上消化道减压引起的低氯性代谢性碱中毒和容量不足较为合适。临床上不加区分地应用盐水对患者特别是对重症患者可能导致不必要的并发症,应注意避免。临床医生对于盐水相关作用和电解质管理的认识亟需增强。
关键词:0.9%氯化钠溶液(盐水);高氯血症;酸中毒;高钾血症;平衡液;肾脏血流动力学

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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