Contributor: Aaron Lessen, MD

Educational Pearls:

  • There has long been many questions about which IV fluid is best for ED resuscitation
  • Multiple adult studies have shown no clear benefit of balanced fluid vs normal saline
  • A large pediatric randomized clinical trial published in April compared balanced fluid vs normal saline in children with septic shock
  • The study included about 9,000 patients from 47 emergency departments in five countries
  • Patients with septic shock were randomized to receive either balanced fluid or normal saline
  • The primary outcome was adverse kidney event (death, dialysis, or persistent kidney dysfunction) at 30 days or hospital discharge

  • Results showed no difference in any safety outcomes and no adverse events occurred

  • The key takeaway is that early fluid resuscitation matters more than which crystalloid you choose

References

  1. Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. New England Journal of Medicine. Published online April 23, 2026. doi:https://doi.org/10.1056/nejmoa2601969

Summarized by Meg Joyce, MS3 | Edited by Meg Joyce & Ahmed Abdel-Hafiz, NREMT-P

Donate: https://emergencymedicalminute.org/donate/

See All 1183 Episodes of "Emergency Medical Minute"