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World J Crit Care Med. Feb 4, 2014; 3(1): 24-33
Published online Feb 4, 2014. doi: 10.5492/wjccm.v3.i1.24
Controversies in fluid therapy: Type, dose and toxicity
Robert C McDermid, Karthik Raghunathan, Adam Romanovsky, Andrew D Shaw, Sean M Bagshaw
Robert C McDermid, Adam Romanovsky, Sean M Bagshaw, Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G2B7, Canada
Karthik Raghunathan, Andrew D Shaw, Department of Anesthesiology, Duke University Medical Center/Durham VAMC, Durham, NC 90484, United States
Andrew D Shaw, Department of Critical Care Medicine, Duke University Medical Center/Durham VAMC, Durham, NC 90484, United States
Author contributions: All the authors contributed to drafting and critical revision of manuscript.
Supported by Canada Research Chair in Critical Care Nephrology; Clinical Investigator Award from Alberta Innovates-Health Solutions to Bagshaw MS
Correspondence to: Dr. Sean M Bagshaw, Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C. Mackenzie Centre, 8440-122 ST NW, Edmonton, AB T6G2B7, Canada. bagshaw@ualberta.ca
Telephone: +1-780-4076755 Fax: +1-780-4071228
Received: June 7, 2013
Revised: October 30, 2013
Accepted: December 12, 2013
Published online: February 4, 2014
Core Tip

Core tip: Fluid therapy is exceedingly common in acutely ill patients; however, numerous questions on the efficacy and safety of fluid therapy in terms of the type and dose remain. Fluid therapy prescription is context-specific and any fluid type can be harmful if administered inappropriately. When considering crystalloids versus colloids, differences in efficacy are modest but the risk of kidney toxicity and bleeding complications with hydroxyethyl starch appear more significant. The differences in chloride load across crystalloid solutions appears to have physiologic and clinically important effects, in particular for contributing to hyperchloremic metabolic acidosis, kidney injury and greater utilization of renal replacement therapy associated with 0.9% saline. Fluid therapy should be viewed as analogous to the prescription of any drug in acutely ill patients.