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“She filled his ancient veins with rich elixir. As he received it his wasted form renewed, appeared in all the vigor of bright youth, no longer lean and sallow, for new blood coursed in his well‐filled veins” (Publius Ovidius Naso, Metamorphoses Book VII – The Story of Medea and Jason, 8 AD).

Our desire to find solutions that rejuvenate and resuscitate is captured in the story of Medea revitalizing Jason’s elderly father by filling his veins with a specially prepared elixir. Although no such elixir exists, intravenous fluids are an integral component of the multimodal resuscitation strategy used in medicine.

Hindi america movie hd download. Intravenous fluids were first administered over 180 years ago and despite their widespread use there remains uncertainty about their relative safety and efficacy. Worldwide, there is variation in the prescribing of resuscitative intravenous fluids and the preferred choice of fluid appears to be based on local customs, marketing, fluid costs and availability [ ]. The majority of intravenous fluids were introduced into clinical practice during an era where they did not undergo the same scrutiny as other drugs. Hence, there is a paucity of research in this area and only recently has there been an increase in academic interest in the comparative effectiveness of different intravenous fluids. Here, we review the composition of different crystalloid fluids, potential pathophysiological responses following crystalloid fluid infusion, evidence from animal studies, observational studies, and interventional studies comparing crystalloid fluids, and suggest future directions for research on the comparative effectiveness of various crystalloid fluids. The composition of 0.9% saline was first mentioned by Jakob Hamburger in the 1890s. It is unknown how 0.9% saline became known as ‘normal saline’; however, use of term ‘normal’ may have contributed to the widespread acceptance of 0.9% saline into clinical practice.

Despite being referred to as ‘normal’, 0.9% saline is not physiologically ‘normal’. First, 0.9% saline has a higher chloride concentration than plasma.

Second, 0.9% saline has a different strong ion difference (SID) to plasma. According to the Stewart physiochemical approach to describing acid‐base balance, fluid pH is in part determined by the SID, which is the sum of the strong cation concentrations in the solution (e.g., sodium, potassium, magnesium), minus the sum of the strong anion concentrations in the solution (e.g., chloride and lactate). The SID of the extracellular fluid is approximately 40 mEq/l, whereas the SID of 0.9% saline is zero. Following an infusion of 0.9% saline there is a net decrease in the plasma SID resulting in a metabolic acidosis. 0.9% saline is often thought of as a relatively hypertonic solution because the sum of its osmotically active components gives a theoretical in vitro osmolality of 308 mosmol/kg H 2O (154 mmol/l sodium plus 154 mmol/l chloride). However, 0.9% saline is more accurately referred to as an isotonic solution as its constituents – sodium and chloride – are only partially active, with an osmotic coefficient of 0.926. The calculated in vivo osmolality (tonicity) of saline is 285 mosmol/kgH 2O, which is the same as plasma osmolality (tonicity).

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Unlike 0.9% saline, the available buffered crystalloid solutions contain physiological or near physiological amounts of chloride. One of the key differences between 0.9% saline and buffered/balanced crystalloids is the presence of additional anions, such as lactate, acetate, malate and gluconate, which act as physiological buffers to generate bicarbonate. Further, buffered fluids, such as Hartmann’s solution and Ringer’s lactate, have near physiologically effective in vivo SIDs of 27 and 29 mEq/l, respectively. In contrast, Plasma‐Lyte 148® has an effective SID in vivo of 50 mEq/l.