Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
A randomized, double blinded, pilot trial to compare the safety and efficacy of sodium chloride and sodium acetate combination intravenous fluids in acute stroke patients.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Qureshi Adnan I, Wasay Mohammad, Saleem Shafaq, Ranjini Nived J, Suri M Fareed K
Аннотация
BACKGROUND AND PURPOSE: Hyperchloremia in acute stroke patients is independently associated with increased rates of death or disability. We aim to compare the effects of a balanced intravenous (IV) fluid composed of 0.9% sodium chloride (NaCl) and sodium acetate (NaOAc) versus standard 0.9% NaCl on serum chloride (Cl) levels and safety outcomes in patients with acute stroke.
PATIENTS AND METHODS: Eighty acute stroke patients (64 ischemic stroke, 16 intracerebral hemorrhages) were randomized within 24 h of onset to one of four IV fluid regimens for 72 h: (1) NaCl 0.9%; (2) NaCl:NaOAc 3:1; (3)2:1; (4)1:1. Serum Cl and creatinine were monitored; safety events were adjudicated independently. Outcomes included 30- and 90-day modified Rankin Scale (mRS) scores.
RESULTS: Groups 2-4 had significantly lower mean serum Cl versus group 1 at day 1 (P = 0.013) and day 2 (P = 0.014), with the lowest Cl in group 4 (1:1 ratio), with no safety concerns. No patient developed acute kidney injury (creatinine > 1.5 mg/dL). One serious adverse event was possibly treatment related. The 2:1 ratio group had the highest proportion of patients achieving mRS 0-2 at 30/90 days.
CONCLUSION: IV NaCl-NaOAc combination fluids effectively reduced serum Cl concentrations in a dose-dependent manner compared with IV NaCl alone, without an associated increase in safety events among acute stroke patients.
PATIENTS AND METHODS: Eighty acute stroke patients (64 ischemic stroke, 16 intracerebral hemorrhages) were randomized within 24 h of onset to one of four IV fluid regimens for 72 h: (1) NaCl 0.9%; (2) NaCl:NaOAc 3:1; (3)2:1; (4)1:1. Serum Cl and creatinine were monitored; safety events were adjudicated independently. Outcomes included 30- and 90-day modified Rankin Scale (mRS) scores.
RESULTS: Groups 2-4 had significantly lower mean serum Cl versus group 1 at day 1 (P = 0.013) and day 2 (P = 0.014), with the lowest Cl in group 4 (1:1 ratio), with no safety concerns. No patient developed acute kidney injury (creatinine > 1.5 mg/dL). One serious adverse event was possibly treatment related. The 2:1 ratio group had the highest proportion of patients achieving mRS 0-2 at 30/90 days.
CONCLUSION: IV NaCl-NaOAc combination fluids effectively reduced serum Cl concentrations in a dose-dependent manner compared with IV NaCl alone, without an associated increase in safety events among acute stroke patients.