Is chloride worth its salt?

Excerpt

Intravenous infusion of salt water to restore circulating blood volume traces its origins to the 1830s cholera pandemic. In a letter to the Lancet dated June 2, 1832, Thomas Latta noted with intravenous saline (of unknown composition) “improvement in the pulse and countenance is almost simultaneous, the cadaverous expression gradually gives place to appearances of returning animation, the livid hue disappears, the warmth of the body returns” [1]. In 1896, Hartog Jakob Hamburger recognized erythrocytes did not lyse in a saline solution and concluded that “the blood of man was isotonic with a NaCl solution of 0.9%”. Although human plasma is closer to 0.6% NaCl, the use of 0.9% “normal” saline became widespread. Other crystalloid solutions with a more buffered electrolyte composition, including lactated Ringer’s, Hartmann’s, and PlasmaLyte, were also introduced into clinical practice. Despite a burgeoning literature about the risks of saline-induced hyperchloremia and acidemia compared to buffered crystalloids, 0.9% saline remains the overwhelming preference for fluid resuscitation, particularly in children [2]. …