Sepsis.
When a child develops septic shock every second counts and the first steps in treatment are to restore blood circulation with intravenous (IV) fluids and to prevent organ damage. But physicians have been divided on the use of balanced crystalloid fluids vs the popular choice of 0.9 per cent normal saline. A large international clinical trial published in The New England Journal of Medicine (NEJM) has shown that balanced fluids can improve some electrolyte abnormalities but don't improve survival or kidney-related outcomes when compared with normal saline.
Researchers conducted a PRoMPT BOLUS pragmatic clinical trial in 47 emergency departments (EDs) in five countries. They enrolled a total of 9,041 children aged 2 months to less than 18 years who had symptoms and signs of septic shock and abnormal perfusion.
Participants were randomly assigned to receive either balanced crystalloid fluid or 0.9% normal saline for fluid resuscitation for up to 48 hours. Finally 4,235 children were included in the balanced-fluid group and 4,247 children in the saline group. The primary outcome was a major adverse kidney event within 30 days of enrolment or hospital discharge that included death, new renal replacement therapy or persistent kidney dysfunction.
This might be something we can stop studying...
Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock | New England Journal of Medicine https://t.co/Av8vicsq5U Adam Cifu (@adamcifu) April 30, 2026
This study did not show any statistically significant difference between the two treatment groups. The rate of major adverse kidney events was 3.4 per cent in children receiving balanced fluids and 3.0 per cent in children receiving normal saline. Researchers also did not see any significant differences in hospital recovery with the median number of days spent in the hospital without a recovery over the first 28 days which was 23 days for both groups.
However balanced fluids had fewer electrolyte abnormalities. Hyperchloremia was seen in 31.4 per cent of children who were receiving balanced fluids compared with 49.0 per cent of children receiving saline, while hypernatremia was seen in 1.8 per cent versus 3.1 per cent. In contrast the balanced fluid group had slightly more cases of hyperlactatemia 19.8 per cent than in the saline group i.e 16.7 per cent. There were no significant differences in other safety outcomes or in adverse events.
If #sepsis is not recognized early and managed promptly, it can lead to septic shock, multiple organ failure & deathhttps://t.co/JbNsGa3ydbpic.twitter.com/M8BcX3PllC
World Health Organization (WHO) (@WHO) September 10, 2020
The findings showed that both balanced crystalloids and normal saline appear to be equally effective as fluids for resuscitation in children who have septic shock. Although balanced fluids did not decrease the risk of death, chronic kidney failure or dialysis, they did help to correct some electrolyte abnormalities. The study reiterates the importance of early diagnosis and treatment of septic shock rather than the decision of the two commonly used IV fluids.
Disclaimer: This content is for informational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for medical decisions.
