Best IV Fluids for Kidney Stones

Rationale for IV Fluid Selection

Balanced crystalloid solutions have an electrolyte composition closer to plasma, which helps maintain acid-base balance and reduces the risk of hyperchloremia, as recommended by the guideline society, according to Praxis Medical Insights 1
0.9% saline has a higher chloride content (154 mmol/L) compared to balanced solutions like Ringer's lactate (108 mmol/L) or Plasmalyte (98 mmol/L), which can lead to hyperchloremic metabolic acidosis when administered in large volumes, as reported in Anaesthesia 2
A recent study showed that balanced solutions are associated with better acid-basic balance compared to 0.9% NaCl, as published in Anaesthesia 3
The KDIGO guidelines suggest using isotonic crystalloids rather than colloids for expansion of intravascular volume in patients at risk for acute kidney injury (AKI) 4

Intravenous fluids should be administered to patients with kidney stones, but caution should be used in determining the amount to avoid fluid overload, as recommended by the American Journal of Kidney Diseases 5

For most patients with kidney stones, administer balanced crystalloid solutions (Ringer's Lactate or Plasmalyte) at maintenance rates, as recommended by Praxis Medical Insights 1
In patients with kidney stones and risk of AKI, isotonic crystalloids are preferred over colloids, according to KDIGO guidelines 4
Synthetic colloids (hydroxyethyl starch, gelatin) should be avoided due to reported risks of renal failure and hemostasis disorders, as reported in Anaesthesia 6

Determine hydration status and presence of comorbidities, and check baseline kidney function, as recommended by the American Journal of Kidney Diseases 5
Avoid colloids due to risk of renal dysfunction, as reported in Anaesthesia 6
Monitor urine output, vital signs, and electrolytes, and adjust fluid rate based on clinical response, as recommended by Praxis Medical Insights and the American Journal of Kidney Diseases 1, 5

Using 0.9% saline for large volume resuscitation can cause hyperchloremic metabolic acidosis, as reported in Anaesthesia and Praxis Medical Insights 1, 2
Synthetic colloids should be avoided due to increased risk of renal dysfunction, as reported in Anaesthesia 6
Discontinuing concomitant nephrotoxins (e.g., NSAIDs, aminoglycosides) is important when administering IV fluids to patients with kidney stones, as recommended by the American Journal of Kidney Diseases 5