In fact, reviewing the total number of studies comparing the two types of fluid regimens, it can be stated that acidosis is the only reproducible effect of the administration of 0.9% NaCl associated with no deleterious clinical consequences. The infusion of 0.9% NaCl causes acidosis, as can be seen in our review of the trials comparing the use of 0.9% NaCl with other crystalloid solutions in Table 1. ![]() Nearly the entire focus of the argument against 0.9% NaCl, from a mechanistic perspective, has been on its effect on acid–base irregularities. In this paper, we hope to discuss the context within which fluids, specifically 0.9% NaCl, can be given in a safe and effective manner. As such the emphasis on fluid resuscitation should be on volume rather than on composition and should be accompanied by a physiological assessment of the impact of fluids. Although it has some deleterious effects, all fluids share common features of concern. We will discuss why 0.9% NaCl solution is the most frequently used resuscitation fluid. It is challenging because of the large amount of literature, including our own, showing adverse effects of 0.9% NaCl. We have the challenging task of defending the use of 0.9% NaCl and reviewing its positive attributes, while an accompanying paper will argue against the use of 0.9% NaCl. The basis of this negative evaluation of 0.9% NaCl is almost exclusively its effect on acid–base homeostasis, whereas the potentially deleterious effects present in other types of crystalloids are neglected. As such, the literature seems to suggest that 0.9% NaCl should be avoided at all costs, whereas alternative crystalloid solutions can be used without scrutiny. Literature on the deleterious effects of 0.9% NaCl has accumulated over the last decade, but critical appraisal of alternative crystalloid solutions is lacking. Although 0.9% NaCl solution is by far the most-used fluid for fluid therapy in resuscitation, it is difficult to find a paper advocating its use over other types of crystalloid solutions.
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