Unbalanced Crystalloid Solutions
Unbalanced/nonbuffered solution mainly refer to 0.9% saline or normal
saline (NS) [59]. The composition of normal saline contains
supraphysiological concentrations of chloride, which often results in a
hyperchloremic state in those resuscitated with NS [59]. As
mentioned above, the impact of hyperchloremia in the critically ill is
of great clinical significance [46-48]. Specifically, hyperchloremia
has been found to be associated with acute kidney injury [47],
non-anion gap metabolic acidosis [63], decreased ventilator free
days [64], bleeding and mortality in the perioperative period
[59]. Despite these clinical sequelae, NS is used frequently
following CABG procedures for perioperative resuscitation, due to its
wide availability and relative low cost [15].