Impact of High‑Volume Chloride‑Rich Intravenous Fluids and Prevention Strategies

Adverse Outcomes of High‑Volume Chloride‑Rich Fluids

Administration of large volumes of chloride‑rich intravenous solutions (greater than 5 L of 0.9 % normal saline) is associated with the development of hyperchloremia and independently increases the risk of mortality and acute kidney injury in hospitalized patients. 1

Replacing 0.9 % normal saline with balanced crystalloid fluids (e.g., Ringer’s Lactate or Plasmalyte) for both resuscitation and maintenance—especially when large fluid volumes are anticipated—reduces the incidence of hyperchloremia and its renal and survival‑related complications. Current evidence does not support a Grade 1 recommendation for balanced solutions in hemorrhagic shock due to insufficient data, but the potential harms of high‑volume chloride‑rich fluids favor balanced solutions as first‑line therapy. 1

In pediatric patients receiving maintenance fluids, hyperchloremic metabolic acidosis caused by 0.9 % saline may impair acid‑base balance; however, studies show inconsistent evidence of a clinically significant effect in this population. 2