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Module 5: Abdominal Injuries

Segment 8: Intravenous Solutions

References labeled PEDS contain a pediatric element or primary focus.

Topic: Isotonic solutions

  • Arabi YM, Belley-Cote E, Carsetti A, et al. European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids. Intensive Care Med. 2024;50(6):813-831. doi: 10.1007/s00134-024-07369-9 https://pubmed.ncbi.nlm.nih.gov/38771364/.
  • Barker ME. 0.9% saline induced hyperchloremic acidosis. J Trauma Nurs. 2015;22(2):111-6. doi: 10.1097/jtn.0000000000000115 https://pubmed.ncbi.nlm.nih.gov/25768968/.
  • Blumberg N, Cholette JM, Pietropaoli AP, et al. 0.9% NaCl (normal saline) - Perhaps not so normal after all? Transfus Apher Sci. 2018;57(1):127-131. doi: 10.1016/j.transci.2018.02.021 https://pubmed.ncbi.nlm.nih.gov/29523397/.
  • Dell’Anna AM, Grieco DL, Dominedò C, et al. Stewart’s theory and acid-base changes induced by crystalloid infusion in humans: a randomized physiological trial. Ann Intensive Care. 2025;15(1):54. doi: 10.1186/s13613-025-01473-9 https://pubmed.ncbi.nlm.nih.gov/40263186/.
  • Diz JC, Luna-Rojas P, Díaz-Vidal P, et al. Effect of treatment with balanced crystalloids versus normal saline on the mortality of critically ill patients with and without traumatic brain injury: A systematic review and meta-analysis. Anesth Analg. 2025;141(1):152-161. doi: 10.1213/ane.0000000000007368 https://pubmed.ncbi.nlm.nih.gov/39832223/.
  • Dong WH, Yan WQ, Song X, et al. Fluid resuscitation with balanced crystalloids versus normal saline in critically ill patients: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2022;30(1):28. doi: 10.1186/s13049-022-01015-3 https://pubmed.ncbi.nlm.nih.gov/35436929/.
  • Gottlieb M, Petrak V, Binkley C. Are balanced crystalloid solutions better than normal saline solution for the resuscitation of children and adult patients? Ann Emerg Med. 2020;75(4):532-534. doi: 10.1016/j.annemergmed.2019.10.001 https://pubmed.ncbi.nlm.nih.gov/31866169/. PEDS
  • Hoorn EJ. Intravenous fluids: balancing solutions. J Nephrol. 2017;30(4):485-492. doi: 10.1007/s40620-016-0363-9 https://pubmed.ncbi.nlm.nih.gov/27900717/.
  • McIntyre L, Fergusson D, McArdle T, et al. A crossover trial of hospital-wide lactated Ringer’s solution versus normal saline. N Engl J Med. 2025;393(7):660-670. doi: 10.1056/NEJMoa2416761 https://pubmed.ncbi.nlm.nih.gov/40503714/.
  • McKee A, Moriber N, Tornwall J. Intravenous fluid therapy choice in trauma patients in the intensive care unit: A scoping review. Crit Care Nurse. 2025;45(2):41-49. doi: 10.4037/ccn2025318 https://pubmed.ncbi.nlm.nih.gov/40168009/.
  • Mekontso Dessap A, AlShamsi F, Belletti A, et al. European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2-the volume of resuscitation fluids. Intensive Care Med. 2025;51(3):461-477. doi: 10.1007/s00134-025-07840-1 https://pubmed.ncbi.nlm.nih.gov/40163133/.
  • Odor PM, Bampoe S, Dushianthan A, et al. Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review. Perioper Med (Lond). 2018;7:27. doi: 10.1186/s13741-018-0108-5 https://pubmed.ncbi.nlm.nih.gov/30559961/.
  • Ostermann M, Randolph AG. Resuscitation fluid composition and acute kidney injury in critical illness. N Engl J Med. 2022;386(9):888-889. doi: 10.1056/NEJMe2200294 https://pubmed.ncbi.nlm.nih.gov/35235731/.
  • Phillips CR, Vinecore K, Hagg DS, et al. Resuscitation of haemorrhagic shock with normal saline vs. lactated Ringer’s: effects on oxygenation, extravascular lung water and haemodynamics. Crit Care. 2009;13(2):R30. doi: 10.1186/cc7736 https://pubmed.ncbi.nlm.nih.gov/19257901/.
  • Reddi BA. Why is saline so acidic (and does it really matter?). Int J Med Sci. 2013;10(6):747-50. doi: 10.7150/ijms.5868 https://pubmed.ncbi.nlm.nih.gov/23630439/.
  • Reddy S, Weinberg L, Young P. Crystalloid fluid therapy. Crit Care. 2016;20:59. doi: 10.1186/s13054-016-1217-5 https://pubmed.ncbi.nlm.nih.gov/26976277/.
  • Richardson T, Wyatt N, Latocha J, et al. Balanced crystalloids or normal saline? A historical and evidence-based perspective. J Intensive Care Med. 2025:8850666251388413. doi: 10.1177/08850666251388413 https://pubmed.ncbi.nlm.nih.gov/41217873/.
  • Self WH, Semler MW, Wanderer JP, et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med. 2018;378(9):819-828. doi: 10.1056/NEJMoa1711586 https://pubmed.ncbi.nlm.nih.gov/29485926/.
  • Semler MW, Kellum JA. Balanced crystalloid solutions. Am J Respir Crit Care Med. 2019;199(8):952-960. doi: 10.1164/rccm.201809-1677CI https://pubmed.ncbi.nlm.nih.gov/30407838/.
  • Semler MW, Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378(9):829-839. doi: 10.1056/NEJMoa1711584 https://pubmed.ncbi.nlm.nih.gov/29485925/.
  • Sen A, Keener CM, Sileanu FE, et al. Chloride content of fluids used for large-volume resuscitation is associated with reduced survival. Crit Care Med. 2017;45(2):e146-e153. doi: 10.1097/ccm.0000000000002063 https://pubmed.ncbi.nlm.nih.gov/27635770/.
  • Todd SR, Malinoski D, Muller PJ, et al. Lactated Ringer’s is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock. J Trauma. 2007;62(3):636-9. doi: 10.1097/TA.0b013e31802ee521 https://pubmed.ncbi.nlm.nih.gov/17414340/.
  • Toyonaga Y, Kikura M. Hyperchloremic acidosis is associated with acute kidney injury after abdominal surgery. Nephrology (Carlton). 2017;22(9):720-727. doi: 10.1111/nep.12840 https://pubmed.ncbi.nlm.nih.gov/27312130/.
  • Weykamp MB, Stern KE, Brakenridge SC, et al. Prehospital crystalloid resuscitation: practice variation and associations with clinical outcomes. Shock. 2023;59(1):28-33. doi: 10.1097/shk.0000000000002039 https://pubmed.ncbi.nlm.nih.gov/36703275/.
  • Wise R, Faurie M, Malbrain M, et al. Strategies for intravenous fluid resuscitation in trauma patients. World J Surg. 2017;41(5):1170-1183. doi: 10.1007/s00268-016-3865-7 https://pubmed.ncbi.nlm.nih.gov/28058475/.
  • Wu MC, Liao TY, Lee EM, et al. Administration of hypertonic solutions for hemorrhagic shock: A systematic review and meta-analysis of clinical trials. Anesth Analg. 2017;125(5):1549-1557. doi: 10.1213/ane.0000000000002451 https://pubmed.ncbi.nlm.nih.gov/28930937/.
  • Zaki HA, Elmelliti H, Shaban A, et al. Balanced crystalloids versus normal saline for trauma resuscitation: A systematic review and meta-analysis. Am J Emerg Med. 2026;101:84-91. doi: 10.1016/j.ajem.2025.12.030 https://pubmed.ncbi.nlm.nih.gov/41475037/.
  • Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: The BaSICS randomized clinical trial. JAMA. 2021;doi: 10.1001/jama.2021.11684 https://pubmed.ncbi.nlm.nih.gov/34375394/.
  • Zampieri FG, Machado FR, Biondi RS, et al. Association between type of fluid received prior to enrollment, type of admission, and effect of balanced crystalloid in critically ill adults: A secondary exploratory analysis of the BaSICS clinical trial. Am J Respir Crit Care Med. 2022;205(12):1419-1428. doi: 10.1164/rccm.202111-2484OC https://pubmed.ncbi.nlm.nih.gov/35349397/.
  • Zitek T, Skaggs ZD, Rahbar A, et al. Does intravenous lactated Ringer’s solution raise serum lactate? J Emerg Med. 2018;55(3):313-318. doi: 10.1016/j.jemermed.2018.05.031 https://pubmed.ncbi.nlm.nih.gov/30037514/.

Topic: Trauma research & controversies

  • Burke E, Hartley B, Succar B, et al. Rethinking vasopressor use in the trauma bay: a shifting perspective. Trauma Surg Acute Care Open. 2025;10(Suppl 1):e001788. doi: 10.1136/tsaco-2025-001788 https://pubmed.ncbi.nlm.nih.gov/40260231/.
  • Price MA, Villarreal CL, Moreno AN, et al. Developing a National Trauma Research Action Plan: Results from the regulatory challenges Delphi survey. J Trauma Acute Care Surg. 2024;96(4):658-665. doi: 10.1097/ta.0000000000004185 https://pubmed.ncbi.nlm.nih.gov/38031274/.
  • Severs D, Hoorn EJ, Rookmaaker MB. A critical appraisal of intravenous fluids: from the physiological basis to clinical evidence. Nephrol Dial Transplant. 2015;30(2):178-87. doi: 10.1093/ndt/gfu005 https://pubmed.ncbi.nlm.nih.gov/24463187/.

Topic: Hypertonic saline

  • de Crescenzo C, Gorouhi F, Salcedo ES, et al. Prehospital hypertonic fluid resuscitation for trauma patients: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2017;doi: 10.1097/ta.0000000000001409 https://pubmed.ncbi.nlm.nih.gov/28257392/.
  • Delano MJ, Rizoli SB, Rhind SG, et al. Prehospital resuscitation of traumatic hemorrhagic shock with hypertonic solutions worsens hypocoagulation and hyperfibrinolysis. Shock. 2015;44(1):25-31. doi: 10.1097/shk.0000000000000368 https://pubmed.ncbi.nlm.nih.gov/25784523/.
  • Fatima N, Ayyad A, Shuaib A, et al. Hypertonic solutions in traumatic brain injury: A systematic review and meta-analysis. Asian J Neurosurg. 2019;14(2):382-391. doi: 10.4103/ajns.AJNS_8_19 https://pubmed.ncbi.nlm.nih.gov/31143250/.
  • Harvin JA, Mims MM, Duchesne JC, et al. Chasing 100%: the use of hypertonic saline to improve early, primary fascial closure after damage control laparotomy. J Trauma Acute Care Surg. 2013;74(2):426-30; discussion 431-2. doi: 10.1097/TA.0b013e31827e2a96 https://pubmed.ncbi.nlm.nih.gov/23354234/.
  • Motaharinia J, Etezadi F, Moghaddas A, et al. Immunomodulatory effect of hypertonic saline in hemorrhagic shock. Daru. 2015;23:47. doi: 10.1186/s40199-015-0130-9 https://pubmed.ncbi.nlm.nih.gov/26437974/.
  • Shi J TL, Ye J, Hu L. Hypertonic saline and mannitol in patients with traumatic brain injury: A systematic and meta-analysis. Medicine (Baltimore). 2020;99(35):e21655. doi: 10.1097/MD.0000000000021655. https://pubmed.ncbi.nlm.nih.gov/32871879/.

Topic: Colloids

  • Dormann J, Dahms K, Steinfeld E, et al. Crystalloid vs colloid fluid resuscitation in polytrauma patients: a systematic review. Eur J Trauma Emerg Surg. 2025;51(1):271. doi: 10.1007/s00068-025-02921-8 https://pubmed.ncbi.nlm.nih.gov/40788415/.
  • Hahn RG, Jardot F, Dull RO, et al. Albumin 20% in surgical and critically ill patients; a comprehensive review. Crit Care. 2026;30(1) doi: 10.1186/s13054-026-05959-1 https://pubmed.ncbi.nlm.nih.gov/41877204/.