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].