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Highly Accessed Open Badges Commentary

Is sodium chloride worth its salt?

Euan McIntosh12 and Peter J Andrews34*

Author Affiliations

1 Department of Anaesthesia & Critical Care, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA, UK

2 The Army Medical Corps, Dreghorn Barracks, Redford Road, The City of Edinburgh Bypass, Edinburgh EH13 9QW, UK

3 Centre for Clinical Brain Sciences, The University of Edinburgh, Chancellor's Building, Edinburgh EH16 4SB, UK

4 NHS Lothian, Western General Hospital, Edinburgh EH12 6ER, UK

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Critical Care 2013, 17:150  doi:10.1186/cc12732

See related research by Roquilly et al.,

Published: 11 June 2013


The choice of fluid for resuscitation of the brain-injured patient remains controversial, and the 'ideal' resuscitation fluid has yet to be identified. Large volumes of hypotonic solutions must be avoided because of the risk of cerebral swelling and intracranial hypertension. Traditionally, 0.9% sodium chloride has been used in patients at risk of intracranial hypertension, but there is increasing recognition that 0.9% saline is not without its problems. Roquilly and colleagues show a reduction in the development of hyperchloremic acidosis in brain-injured patients given 'balanced' solutions for maintenance and resuscitation compared with 0.9% sodium chloride. In this commentary, we explore the idea that we should move away from 0.9% sodium chloride in favor of a more 'physiological' solution.