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Debate May Continue Over Crystalloid Solutions and IVF Resuscitation

September 9, 2025

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McIntyre L, Fergusson D, McArdle T, et al. A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution versus Normal Saline. N Engl J Med 2025;393:660-670.

Crystalloid fluids, including normal saline and lactated Ringer’s solution, are among the most common interventions used in the treatment of hospitalized patients to reestablish hemodynamic stability, replace fluid losses, or maintain intravascular volume. Whether lactated Ringer’s solution is clinically superior to normal saline for routine intravenous administration of fluids has been the subject of debate.

Lauralyn McIntyre, from the University of Ottawa, and other members of the Canadian Critical Care Trials Group in Canada conducted an open-label, two-period, two-sequence, cross-sectional, cluster-randomized, crossover trial to compare outcomes in patients that had received lactated Ringer’s solution compared with normal saline.

Between August 2016 and March 2020, seven hospitals completed the required two 12-week periods of using either lactated Ringer’s solution only hospital-wide or normal saline solution only hospital-wide. Data on the primary outcome—composite of death or readmission within 90 days after the index admission—were available for 43,626 eligible patients. 

No serious adverse events were reported, and the researchers found no significant difference in patient outcomes.

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