Grant: Project Grant

Patients who are acutely ill and admitted to a hospital will likely receive salt fluids to help improve blood pressure, and maintain vital organs (ex: heart and kidney) and the circulatory system. Two salt fluids most commonly used for these purposes are normal saline and Ringer's lactate. Both salt fluids have been used for several decades. Until recently, it was thought the fluids are essentially equivalent other than some minor differences related to the concentration of salt components and buffers that are contained to reduce acid in the blood. Normal saline is the dominant fluid used and contains more sodium and chloride than Ringer's lactate. In contrast to normal saline, Ringer's lactate contains a buffer as well as a small amount of potassium and calcium. Recent data suggests that salt fluids that contain less chloride like Ringer's lactate, may cause less acid in the blood, and less kidney failure and death. But Ringer's is more expensive than saline and previous studies have been small or had weak designs. To answer this question with confidence, it requires many patients to be recruited into the trial from many hospitals, using a process of randomization. Such a large sample size is required when the expected differences in study outcomes between the two fluids are small. Our research team will conduct a novel pragmatic randomized trial in 16 hospitals where each hospital stocks exclusively one type of fluid for 3 months and then switches to stocking the other fluid for another 3 months. We will determine if Ringer's lactate versus normal saline reduces death and re-admissions to hospital, emergency department visits, need for dialysis, surgical re-operation or re-intubation, and discharge to a facility other than home. Our team will also conduct a costing analysis. The information gained from FLUID will have a significant impact on fluid therapy practise and is relevant to patients, clinicians, and the Health Care System.