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

1. 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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