Optimal fluid management for acute kidney injury with sepsis
Is there an optimal fluid management approach for patients with acute kidney injury with sepsis?
Several studies have addressed whether various intravenous fluids are superior to one another in the treatment of patients with sepsis.
These trials have compared albumin, normal (0.9%) saline, various starches, and a balanced pH solution (such as lactated ringers or in various combinations).
The bottom line from trials is that volume expansion with normal (0.9%) saline is either associated with similar if not better outcomes than other intravenous solutions.
Of note, the various starch solutions have been associated with an increased incidence of acute kidney injury and poor outcomes, and should be avoided.
Thus, a reasonable initial approach for volume resuscitation in the patient with sepsis is to initiate therapy with intravenous normal (0.9%) saline, and if the patient develops a metabolic acidosis associated with a high chloride load, then switch to a more balanced pH solution, such as Lactated Ringer’s.