Order Substitutions and Education for Balanced Crystalloid Solution Use in an Integrated Health Care System and Association With Major Adverse Kidney Events

Abstract

Intravenous fluids are the most commonly prescribed medical therapy in the US, with an estimated 200 million liters of crystalloid administered annually.^1,2 Emerging evidence suggests that normal saline (NS; 0.9% sodium chloride) solution is associated with hyperchloremic metabolic acidosis, increases in proinflammatory cytokines, decreased kidney perfusion, acute kidney injury, and mortality.^3-10 Nevertheless, outcomes associated with different crystalloid formulations have historically been sparsely studied.