Emergency Medical Minute11 Touko

Podcast 1005: Balanced Fluid vs Normal Saline in Pediatric Patients

Contributor: Aaron Lessen, MD

Educational Pearls:

There has long been many questions about which IV fluid is best for ED resuscitation
Multiple adult studies have shown no clear benefit of balanced fluid vs normal saline
A large pediatric randomized clinical trial published in April compared balanced fluid vs normal saline in children with septic shock

The study included about 9,000 patients from 47 emergency departments in five countries
Patients with septic shock were randomized to receive either balanced fluid or normal saline
The primary outcome was adverse kidney event (death, dialysis, or persistent kidney dysfunction) at 30 days or hospital discharge
Results showed no difference in any safety outcomes and no adverse events occurred

The key takeaway is that early fluid resuscitation matters more than which crystalloid you choose

References

Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. New England Journal of Medicine. Published online April 23, 2026. doi:https://doi.org/10.1056/nejmoa2601969

Summarized by Meg Joyce, MS3 | Edited by Meg Joyce & Ahmed Abdel-Hafiz, NREMT-P

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