Background: Fluid resuscitation is a common practice in emergency departments. Both Normal Saline (NS) and balanced fluids have been proposed for fluid resuscitation. Most patients need fluid resuscitation before the definitive diagnosis is made. To compare the immediate outcomes of early resuscitation with NS (0.9% sodium chloride) versus Lactated Ringer’s solution (LR) in patients admitted to an emergency department. Methods: This was a parallel cluster-randomized, triple-blind, controlled trial. Eligibility criteria included a need for fluid resuscitation, no contraindication for NS or RL resuscitation, and agreement to sign the written consent form. Patients in the emergency department were allocated using a parallel-cluster design, with consecutive three-day clusters assigned to either NS or LR using a random table. Blinding was maintained by using identical labeled intravenous fluids, with only the drug provider aware of the codes. Data on IV fluid type, dose, initiation time, and patients’ demographics were recorded. Baseline and follow-up measurements of serum creatinine, urea, potassium, and serum pH were taken at 6 hours post-admission. The primary outcomes were in-hospital death and the duration of emergency department and hospital stays. Secondary outcomes included the occurrence of acute kidney injury (based on creatinine clearance) and hyperkalemia. Results: During the study period, 1114 patients were included in the final analysis. Women constituted 271 (49.01%) individuals in the LR group and 270 (48.12%) individuals in the NS group. The average ages in the two groups were 53.35 and 53.52 years, respectively. Hospital and emergency department stays were significantly lower in the LR group compared with the NS group (p=0.001). There is no significant difference between the two groups about death (p=0.390), hyperkalemia (p=0.960), and acute kidney injury (p=0.652). Conclusion: It appears that LR is superior to NS for initial resuscitation in the emergency department, as its administration is associated with shorter hospital and emergency department stays, without significant adverse events, compared to NS.
Sadrabad et al. (Fri,) studied this question.