Saline versus balanced hydroxyethyl starch: does it matter?

SUMMARY The type of fluid used for correcting hypovolemia is still a matter of debate. There is increasing evidence that the choice of fluid may result in the development of hyperchloremic acidosis. As the base excess has been shown to be a valuable tool to diagnose circulatory derangements, development of metabolic acidosis by unbalanced fluids should be avoided because a low base excess caused by the choice of fluid is limiting this diagnostic armamentarium. Additionally, infusion of considerable amounts of volume with a non‐physiologic electrolyte composition appears to be associated with negative effects on coagulation, bleeding, blood flow, renal and gut function as well as on patient comfort. New light on this issue is shed by the introduction of a balanced volume replacement concept. This concept includes administration of balanced crystalloids and balanced colloids when necessary. As hydroxyethyl starch (HES), the colloid most commonly used in Europe, is solved in non‐physiologic saline solution, HES cannot fulfill the idea of a complete balanced volume replacement strategy. Preparing HES in a balanced solvent is supposed to reduce some substance‐specific negative effects. At present, information on the value of a total balanced volume replacement strategy is limited. Although it remains to be elucidated whether high doses or repetitive use of such a fluid replacement concept would be of advantage compared with a non‐balanced regimen with regard to mortality and morbidity, there are no arguments for refusing a balanced, plasma‐adapted volume replacement concept including a balanced HES.