Saline Against Lactated Ringers or Plasmalyte in the Emergency Department

The administration of intravenous fluids is ubiquitous in the care of the acutely ill.
Commonly available isotonic crystalloid solutions contain a broad spectrum of electrolyte
compositions including a range chloride concentrations. Recent studies have associated
solutions with supraphysiologic chloride content with hyperchloremia, metabolic acidosis and
renal vasoconstriction, acute kidney injury and renal replacement therapy, and increased
mortality but no large, randomized-controlled trials have been conducted. SaLt-ED will be a
large, cluster-randomized trial enrolling adults requiring intravenous isotonic crystalloid
administration and hospital admission from the Vanderbilt University Emergency Department
from January 1st 2016 until April 30 2017. The primary endpoint will be hospital-free days to
day 28.

Inclusion Criteria:

1. Patient in the Vanderbilt Adult Emergency Department

2. Felt by treating clinician to require intravenous isotonic crystalloid

3. Felt by treating clinician to require inpatient hospital admission

Exclusion Criteria:

1. Age < 18 years