Hyperchloremic Metabolic Acidosis Following Intravenous Saline Administration: A Systematic Review

Abstract

Objectives: To systematically review and synthesize available literature on saline-induced hyperchloremic metabolic acidosis (HMA). Methods: A comprehensive search across four databases identified 209 publications. Duplicates were removed using Rayyan QCRI, and relevance screening reduced the selection to 40 full-text articles. After further review, seven studies met the inclusion criteria. Results: We included seven studies with a total of 205 participants who received saline infusion and the majority 129 (62.9%) were males. The incidence of HMA following saline infusion ranged from 54.8% in pediatric septic shock cases to 100% in healthy volunteers receiving hypertonic saline. Saline solutions, particularly normal and hypertonic saline, are frequently associated with metabolic disturbances, including HMA and reduced acid-base balance, especially in surgical and critically ill patients. In contrast, balanced crystalloid solutions do not induce HMA and support better patient outcomes by maintaining metabolic stability. Balanced salts significantly reduce the incidence of HMA in pediatric septic shock and enhance tissue perfusion while reducing acidosis risk in elderly surgical patients. Conclusion: This review highlights the metabolic risks of saline solutions and the clear benefits of balanced crystalloids in preventing HMA. Transitioning to balanced fluids in clinical practice can enhance patient safety and outcomes across various settings. Further research is needed to explore long-term impacts and develop standardized guidelines for intravenous fluid use, ensuring evidence-based care and minimizing complications.