Intravenous Fluids: Balancing Solutions

J Nephrol. 2017 Aug;30(4):485-492. doi: 10.1007/s40620-016-0363-9. Epub 2016 Nov 29.


The topic of intravenous (IV) fluids may be regarded as "reverse nephrology", because nephrologists usually treat to remove fluids rather than to infuse them. However, because nephrology is deeply rooted in fluid, electrolyte, and acid-base balance, IV fluids belong in the realm of our specialty. The field of IV fluid therapy is in motion due to the increasing use of balanced crystalloids, partly fueled by the advent of new solutions. This review aims to capture these recent developments by critically evaluating the current evidence base. It will review both indications and complications of IV fluid therapy, including the characteristics of the currently available solutions. It will also cover the use of IV fluids in specific settings such as kidney transplantation and pediatrics. Finally, this review will address the pathogenesis of saline-induced hyperchloremic acidosis, its potential effect on outcomes, and the question if this should lead to a definitive switch to balanced solutions.

Keywords: Balanced crystalloids; Hyperchloremic acidosis; Hyponatremia; Hypotonic fluids; Kidney transplantation; Pediatrics.

Publication types

  • Review

MeSH terms

  • Acid-Base Equilibrium / drug effects
  • Acidosis / blood
  • Acidosis / chemically induced
  • Acidosis / physiopathology
  • Chlorine / blood
  • Crystalloid Solutions
  • Fluid Therapy / adverse effects
  • Fluid Therapy / methods*
  • Humans
  • Infusions, Intravenous
  • Isotonic Solutions / administration & dosage*
  • Isotonic Solutions / adverse effects
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / methods*
  • Pediatrics / methods*
  • Sodium Chloride / administration & dosage*
  • Sodium Chloride / adverse effects
  • Treatment Outcome
  • Water-Electrolyte Balance / drug effects*


  • Crystalloid Solutions
  • Isotonic Solutions
  • Sodium Chloride
  • Chlorine