A COMPARITIVE STUDY OF NORMAL SALINE AND MULTIELECTROLYTE SOLUTION IN CRITICAL ILL PATIENTS WITH ACUTE KIDNEY INJURY

Abstract

Background:In critically ill patients with acute kidney injury, the choice of
intravenous fluids can mean the difference between recovery and worsening
renal failure. Normal saline despite its widespread use has been linked to
hyperchloremia, acidosis, and impaired kidney function. In contrast, multiple
electrolyte solutions or balanced electrolytes, may provide a more physiologic
alternative , potentially improving renal outcomes and survival. This study
compares the effects of NS and MES on mortality and renal function in icu
patients with AKI
Objectives: This study aimed to evaluate the impact of NS and MES on renal
function and survival in critically ill patients with acute kidney injury, focusing
on primary outcomes such as Mortality, and changes in s cr levels( baseline vs
peak and trend over time), and secondary outcomes including hemodynamic
stability and incidence of hyperchloremia(s.cl level>110)
Methods:This prospective observational cohort study, conducted in a tertiary
care ICU including critically ill patients diagnosed with acute kidney injury,
100 patients randomized into two groups: Group A (NS) and Group B (MES).,
and the primary outcome was Mortality and renal function assessed via serum
creatinine levels. Secondary outcomes included serum chloride, and
hemodynamic parameters(MAP) over 7 days.
Results:Both groups had similar baseline characteristics, with a median
treatment duration of 6.5 days. The MES group showed significantly lower
mortality rate compared to NS group, MES group had a significantly lower
creatinine levels indicating better renal function preservation. NS group
associated with higher risk of hyperchloremia. MAP , lower MAP at 12 and 24
hours after fluid resuscitation.
Conclusion: Fluid choice in critically ill patients with AKI significantly
impacts renal function, hemodynamics and survival outcomes.Both NS and
MES are effective in managing critically ill patients, but MES offers advantages
in maintaining acid-base stability and a balanced chloride profile. These
findings suggest MES may be the preferred option in cases where acidosis or
hyperchloremia is a concern. Further research is warranted to explore the longterm clinical implications of these differences.