Balanced fluids in the ED. The SPLIT, SALT-ED and SMART trials

This month we will be looking at one of the “hot topics” in the EM and Critical Care namely, balanced fluids vs normal saline in ED and Critical Care patients. Historically, there has been some data to suggest that unbalanced fluids may cause acute kidney injury, hyperchloremic metabolic acidosis and increases in mortality. We will cover two new pragmatic studies published recently in the NEJM that look at ICU and non-ICU patients as well as another widely cited study from New Zealand in 2015, the SPLIT trial. Should this new data be considered “practice changing” or not yet ready for broad application? 


Young P et al Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial. JAMA. 2015 Oct 27;314(16):1701-10. Appraisal

Semler MW et al Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018 Mar 1;378(9):829-839.  Appraisal

 Self WH, et al, Balanced Crystalloids versus Saline in Non-critically Ill Adults. N Engl J Med. 2018 Mar 1;378(9):819-828. Appraisal