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A Tale of Two Solutions

High vs Low-Chloride Intravenous Fluids

Wanderer, Jonathan P., MD, MPhil; Nathan, Naveen, MD

doi: 10.1213/ANE.0000000000002769
Infographics: Infographic

Vanderbilt University School of Medicine (

Northwestern University Feinberg School of Medicine (

The Infographic is composed by Jonathan P. Wanderer, MD, MPhil, Vanderbilt University School of Medicine (, and Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The authors declare no conflicts of interest.



While normal saline remains the most commonly utilized intravenous fluid in medicine and has long been a traditional choice, the delivery of solutions with supraphysiologic concentrations of chloride has consistently been associated with a hyperchloremic acidosis. In experimental studies, high-chloride intravenous fluids have been associated with worsened outcomes, while clinical trials have had mixed results for similar end points. In this infographic, we review the composition of commonly utilized low- and high-chloride intravenous fluids as well as summarize the associated studied outcomes.

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1. Kawano-Dourado L, Zampiere FG, Azevedo LCP, et al. Low- versus high-chloride content intravenous solutions for critically ill and perioperative adult patients: a systematic review and meta-analysis. Anesth Analg. 2018;126:513–521.
© 2018 International Anesthesia Research Society