The Paper That Made Me Rename Normal Saline

In the SALT-ED trial of 13,347 noncritically ill adults receiving IV fluids in the emergency department, balanced crystalloids (mainly lactated Ringer's) reduced major adverse kidney events at 30 days compared with normal saline (4.7% vs 5.6%; adjusted OR 0.82, 95% CI 0.70–0.95, P=0.01). There was no difference in hospital-free days. The proposed mechanism is the supraphysiologic chloride load in saline, which causes hyperchloremic metabolic acidosis.