Alright. Let's put the conversation to bed. Another head to head trial. Hartmanns VS Normal Saline.

You can confide in me.
I know you've spent several lunch breaks daydreaming about fluid bags. I've done it too 😌

Hartmanns or Saline. Saline or Hartmann's. Your consultant says Hartmann's is king. Less chloride, less hyperchloremic acidosis. Your reg shrugs. "Mate, it's just salty water."

Who is right? Let's look at the FLUID trial.

What did the FLUID trial test?

In a new paper, published in the New England Journal of Medicine, researchers set out to compare the effectiveness of a hospital-wide policy using lactated Ringers solution (aka Hartmann's) vs normal saline for IV fluid.

This open-label, two-sequence RCT took place across seven hospitals in Ontario, Canada – caring for 43,626 patients included in the trial.

The hospitals were randomised to give either Hartmann's or normal saline to their patients. Randomised hospital-wide fluid protocols. No in-between.

Twelve weeks of Hartmann's.
Twelve weeks of Saline.
Then swap.

One fluid per site, per period. No mix 'n' match. You get what the trolley says.

The primary aim of the game was to see what the difference in deaths and readmission would be, between the two groups, 90 days after the initial admission.

What did they find?

Primary outcome: The mean incidence of the composite primary outcome was 20.3% with Hartmann's whilst it was 21.4%. Marking a non-significance difference on patient outcomes regardless of fluid choice.

Secondary outcome: For all the secondary measures (ED visits, dialysis initiation, length of hospital stay, or discharge to facility other than home) there was also no significant difference.

Safety: No serious adverse events attributed to the trial fluids. Phew.

What are the caveats?

Of course, no study is without its flaws. The trial initially wanted 16 hospitals involved, but a pesky virus called COVID-19 meddled with their plans. Only the 7 completed its trial, thus limiting the sample size. And maybe more importantly, compliance with the assigned fluid did vary. 93.6% normal saline, but 78.2% with the Hartmann's.

Well. That settles it. Hartmann's = Normal Saline. Pick your poison. If you have balls, take this study to your consultant. Just hope they're not a reader of the Handover too.