Table 3: Resuscitation fluids
Fluid Advantages Disadvantages
Lactate ringer Provides better buffer for metabolic
acidosis
Increases endothelial dysfunction and neutrophil activation with
increase in cellular damage[40]
Normal saline Commonly used for resuscitation, no
immunological effects
Causes hyperchloremic acidosis especially when given in large doses,
increased incidence of dilutional coagulopathy[41]
Human serum
albumin
Decreased volume required as compared
to crystalloids
1.68 fold increase in relative risk of death as compared to crystalloids[42]
Leakage to extra vascular spaces leads to worsening of edema
Increased mortality for patients with TBI who were resuscitated with
4% albumin (SAFE trail — 2007 sub group analysis)[43]
Hypertonic saline Volume expansion and positive
immunological effects; especially used in
TBI for raised intracranial tension (ICP)[13]
Concerns regarding hypernatremia and hyperchloremia exists[13]
Hypertonic saline
with dextran
Increases cerebral perfusion in head injury
with hemorrhagic shock, decrease ICP[13]
Posttrauma attenuation of multi organ dysfunction[13]
Blood transfusion Reduces the requirement of cyrstalloids Needs cross matching, usually not available immediately, usual
transfusion related complication