World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website http://www.wjnu.org

Original Article

Volume 7, Number 2, June 2018, pages 39-44

Balanced Crystalloid Solution Versus Normal Saline on Biochemical Outcomes in Acute Medical and Surgical Patients

Figure 1. Criteria used for exclusion to obtain list of patients for final analysis. *Number of patients satisfying each exclusion criteria overlapped with other criteria. In total, there were 937 patients excluded from this study. CSL: compound sodium lactate; ICU: intensive care unit; IV: intravenous; NS: normal saline.

Figure 2. Post-infusion mean values of electrolytes between NS and CSL cohorts. There were no significant differences in the mean values of serum sodium, chloride and bicarbonate post-infusion of both normal saline and compound sodium lactate.

**Table 1.** Characteristics of Patients Who Received Intravenous Fluids During Their Admission
Demographics	Fluid infusion given	All patients (n = 221)	P-value
SD: standard deviation; ACEI: ACE inhibitor; ARB: angiotensin II receptor blocker; NSAID: non-steroidal anti-inflammatory drug. The specific ACEIs (ramipril, perindopril, fosinopril, enalapril), ARBs (candesartan, irbesartan, telmisartan, olmesartan), and NSAIDs (aspirin, ibuprofen, celecoxib, diclofenac) were also recorded.
Age, mean (SD), year	76.4 (17.5)	57.9 (21.6)	71.6 (20.3)	< 0.0001
Men	62 (37.8%)	22 (38.6%)	84 (38.0%)	0.9155
Admitting unit
Medical	153 (93.3%)	16 (28.1%)	169 (76.5%)	< 0.0001
Surgical	11 (6.7%)	41 (71.9%)	52 (23.5%)	< 0.0001
Comorbidities
Hypertension	79 (48.2%)	18 (31.6%)	97 (43.9%)	0.0297
Ischemic heart disease	32 (19.5%)	5 (8.8%)	37 (16.7%)	0.0614
Diabetes mellitus	46 (28.0%)	12 (21.1%)	58 (26.2%)	0.3010
Chronic respiratory disease	30 (18.3%)	9 (15.8%)	39 (17.6%)	0.6693
Medications
ACEI/ARBs	58 (35.4%)	10 (17.5%)	68 (30.8%)	0.0651
NSAIDs	62 (37.8%)	10 (17.5%)	72 (32.6%)	0.0049
Loop diuretics	56 (34.1%)	9 (15.8%)	65 (29.4%)	0.0088
Thiazide diuretics	9 (5.5%)	4 (7.0%)	13 (5.9%)	0.6724
Potassium sparing diuretics	11 (6.7%)	3 (1.8%)	12 (5.4%)	0.6998

Table 1. Characteristics of Patients Who Received Intravenous Fluids During Their Admission

Demographics

Fluid infusion given

All patients (n = 221)

P-value

NS (n = 164)

CSL (n = 57)

SD: standard deviation; ACEI: ACE inhibitor; ARB: angiotensin II receptor blocker; NSAID: non-steroidal anti-inflammatory drug. The specific ACEIs (ramipril, perindopril, fosinopril, enalapril), ARBs (candesartan, irbesartan, telmisartan, olmesartan), and NSAIDs (aspirin, ibuprofen, celecoxib, diclofenac) were also recorded.

Age, mean (SD), year

76.4 (17.5)

57.9 (21.6)

71.6 (20.3)

< 0.0001

Men

62 (37.8%)

22 (38.6%)

84 (38.0%)

0.9155

Admitting unit

Medical

153 (93.3%)

16 (28.1%)

169 (76.5%)

< 0.0001

Surgical

11 (6.7%)

41 (71.9%)

52 (23.5%)

< 0.0001

Comorbidities

Hypertension

79 (48.2%)

18 (31.6%)

97 (43.9%)

0.0297

Ischemic heart disease

32 (19.5%)

5 (8.8%)

37 (16.7%)

0.0614

Diabetes mellitus

46 (28.0%)

12 (21.1%)

58 (26.2%)

0.3010

Chronic respiratory disease

30 (18.3%)

9 (15.8%)

39 (17.6%)

0.6693

Medications

ACEI/ARBs

58 (35.4%)

10 (17.5%)

68 (30.8%)

0.0651

NSAIDs

62 (37.8%)

10 (17.5%)

72 (32.6%)

0.0049

Loop diuretics

56 (34.1%)

9 (15.8%)

65 (29.4%)

0.0088

Thiazide diuretics

9 (5.5%)

4 (7.0%)

13 (5.9%)

0.6724

Potassium sparing diuretics

11 (6.7%)

3 (1.8%)

12 (5.4%)

0.6998

**Table 2.** Post-Infusion Mean Serum Electrolyte Values Comparing Normal Saline and Compound Sodium Lactate Infused Patients
Biochemistry	Concentration (mmol/L) ± SD
CSL: compound sodium lactate; NS: normal saline; SD: standard deviation.
Medical	(n = 153)	(n = 16)
Serum sodium	139.2 ± 4.7	140.0 ± 4.0	0.5127
Serum chloride	98.9 ± 5.2	99.4 ± 5.5	0.7163
Serum bicarbonate	26.9 ± 3.6	27.0 ± 3.6	0.9159
Surgical	(n = 11)	(n = 41)
Serum sodium	140.9 ± 3.7	140.1 ± 2.1	0.3511
Serum chloride	100.6 ± 3.4	100.2 ± 2.2	0.6378
Serum bicarbonate	26.7 ± 3.3	27.5 ± 2.5	0.3834
All patients	(n = 164)	(n = 57)
Serum sodium	139.3 ± 4.6	140.1 ± 2.7	0.2164
Serum chloride	99.0 ± 5.1	100.0 ± 3.4	0.1700
Serum bicarbonate	26.9 ± 3.6	27.4 ± 2.8	0.3418

Table 2. Post-Infusion Mean Serum Electrolyte Values Comparing Normal Saline and Compound Sodium Lactate Infused Patients

Biochemistry

Concentration (mmol/L) ± SD

CSL

P-value

CSL: compound sodium lactate; NS: normal saline; SD: standard deviation.

Medical

(n = 153)

(n = 16)

Serum sodium

139.2 ± 4.7

140.0 ± 4.0

0.5127

Serum chloride

98.9 ± 5.2

99.4 ± 5.5

0.7163

Serum bicarbonate

26.9 ± 3.6

27.0 ± 3.6

0.9159

Surgical

(n = 11)

(n = 41)

Serum sodium

140.9 ± 3.7

140.1 ± 2.1

0.3511

Serum chloride

100.6 ± 3.4

100.2 ± 2.2

0.6378

Serum bicarbonate

26.7 ± 3.3

27.5 ± 2.5

0.3834

All patients

(n = 164)

(n = 57)

Serum sodium

139.3 ± 4.6

140.1 ± 2.7

0.2164

Serum chloride

99.0 ± 5.1

100.0 ± 3.4

0.1700

Serum bicarbonate

26.9 ± 3.6

27.4 ± 2.8

0.3418

**Table 3.** Summary Statistics of Patient Outcomes Broken Down by Fluid Infusion Received
Outcomes	No.
KDIGO: Kidney Disease: Improving Global Outcomes clinical practice guideline 2009.
Length of stay, mean (SD), days	5.8 (4.9)	3.5 (2.2)	0.0007
Acute kidney injury (KDIGO)	10 (6.1%)	0 (0.0%)	0.0564
Death during admission	6 (3.7%)	0 (0.0%)	0.1432

Table 3. Summary Statistics of Patient Outcomes Broken Down by Fluid Infusion Received

Outcomes

No.

NS (n = 164)

CSL (n = 57)

P-value

KDIGO: Kidney Disease: Improving Global Outcomes clinical practice guideline 2009.

Length of stay, mean (SD), days

5.8 (4.9)

3.5 (2.2)

0.0007

Acute kidney injury (KDIGO)

10 (6.1%)

0 (0.0%)

0.0564

Death during admission

6 (3.7%)

0 (0.0%)

0.1432