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Letters to the Editor: Letters & Announcements

In Response

Moritz, Michael L., MD; Ayus, Juan C., MD

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doi: 10.1213/ANE.0b013e3181f70826
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As Houghton1 and Roth2 point out, Plasma-Lyte 148 is more physiologic than either 0.9% NaCl or lactated Ringer's solution, because it is both isotonic and balanced with respect to plasma base. For this reason, Plasma-Lyte 148 is also used at our institution when large volumes of intraoperative fluid are required. The topic of our editorial3 was not the choice of intraoperative fluid but rather postoperative fluid therapy, in particular maintenance parenteral fluids in the postoperative setting. Maintenance parenteral fluids typically contain 5% dextrose to prevent tissue catabolism. Since 2005, Plasma-Lyte 148 is no longer available with 5% dextrose and in most cases is not suitable as a postoperative maintenance parenteral fluid. In addition, the volume of fluids required postoperatively is usually not great enough for dilutional acidosis to be of major concern with the use of 0.9% sodium chloride. In a head-to-head comparison, Plasma-Lyte 148 (Na 140 mEq/L) is certainly superior to lactated Ringer's solution (Na 130 mEq/L), because it is an isotonic fluid and better prevents the development of hyponatremia. It should be noted the both Plasma-Lyte 148 and lactated Ringer's solution contain potassium (5 and 4 mEq/L, respectively), and therefore should be used with caution if there is renal impairment.

Michael L. Moritz, MD

Children's Hospital of Pittsburgh of UPMC

Pittsburgh, Pennsylvania

Juan C. Ayus, MD

Renal Consultants of Houston

Houston, Texas


1. Houghton J, Wilton N. Choice of isotonic perioperative fluid in children. Anesth Analg 2011;112:246–7
2. Roth JV. Pediatric postoperative fluid therapy: avoiding hyponatremia. Anesth Analg 2011;112:246
3. Moritz M, Ayus JC. Water water everywhere: standardizing postoperative fluid therapy with 0.9% normal saline. Anesth Analg 2010;110:293–5
© 2011 International Anesthesia Research Society