ABSTRACT
The options for replacement include crystalloids or colloids. The three main crystalloids are hypertonic saline, normal saline (NS), and balanced (buffered) salt solutions. The most commonly used balanced salt solution in the United States is lactated Ringer's (LR). The side effect profile of NS, such as hyperchloremic acidosis and potential renal injury, tempers enthusiasm by some intensivists for its use. LR and similar solutions are the most common crystalloids used to treat hypovolemia. Due to uncertainty as to the benefit of the use of albumin over crystalloid, a prospective, randomized multi-center trial was performed comparing 4% albumin to NS when fluid administration was determined to be necessary to maintain or increase intravascular volume. The incidence of acute kidney injury was higher in the albumin group but did not translate into persistent renal insufficiency. It is unclear how to interpret these results as regression analysis shows correlation not causation.
