The great fluid debate: saline or so-called "balanced" salt solutions?

BACKGROUND Intravenous fluids are commonly prescribed in childhood. 0.9 % saline is the most-used fluid in pediatrics as resuscitation or maintenance solution. Experimental studies and observations in adults suggest that 0.9 % saline is a poor candidate for fluid resuscitation. Although anesthesiologists, intensive care specialists, perioperative physicians and nephrologists have been the most active in this debate, this issue deserves some physiopathological considerations also among pediatricians. RESULTS As compared with so-called "balanced" salt crystalloids such as lactated Ringer, administration of large volumes of 0.9 % saline has been associated with following deleterious effects: tendency to hyperchloremic metabolic acidosis (called dilution acidosis); acute kidney injury with reduced urine output and salt retention; damaged vascular permeability and stiffness, increase in proinflammatory mediators; detrimental effect on coagulation with tendency to blood loss; detrimental gastrointestinal perfusion and function; possible uneasiness at the bedside resulting in unnecessary administration of more fluids. Nevertheless, there is no firm evidence that these adverse effects are clinically relevant. CONCLUSIONS Intravenous fluid therapy is a medicine like insulin, chemotherapy or antibiotics. Prescribing fluids should fit the child's history and condition, consider the right dose at the right rate as well as the electrolyte levels and other laboratory variables. It is unlikely that a single type of fluid will be suitable for all pediatric patients. "Balanced" salt crystalloids, although more expensive, should be preferred for volume resuscitation, maintenance and perioperatively. Lactated Ringer appears unsuitable for patients at risk for brain edema and for those with overt or latent chloride-deficiency. Finally, in pediatrics there is a need for new fluids to be developed on the basis of a better understanding of the physiology and to be tested in well-designed trials.

Seawater carbonate chemistry and biological processes of coral Acropora muricata during experiments and observations in La Saline fringing reef, La Reunion Island, western Indian Ocean, 2011

The effect of decreasing aragonite saturation state (Omega Arag) of seawater (elevated pCO2) on calcification rates of Acropora muricata was studied using nubbins prepared from parent colonies located at two sites of La Saline reef (La Réunion Island, western Indian Ocean): a back-reef site (BR) affected by nutrient-enriched groundwater discharge (mainly nitrate), and a reef flat site (RF) with low terrigenous inputs. Protein and chlorophyll a content of the nubbins, as well as zooxanthellae abundance, were lower at RF than BR. Nubbins were incubated at ~27°C over 2 h under sunlight, in filtered seawater manipulated to get differing initial pCO2 (1,440-340 µatm), Omega Arag (1.4-4.0), and dissolved inorganic carbon (DIC) concentrations (2,100-1,850 µmol/kg). Increasing DIC concentrations at constant total alkalinity (AT) resulted in a decrease in Omega Arag and an increase in pCO2. AT at the beginning of the incubations was kept at a natural level of 2,193 ± 6 µmol/kg (mean ± SD). Net photosynthesis (NP) and calcification were calculated from changes in pH and AT during the incubations. Calcification decrease in response to doubling pCO2 relative to preindustrial level was 22% for RF nubbins. When normalized to surface area of the nubbins, (1) NP and calcification were higher at BR than RF, (2) NP increased in high pCO2 treatments at BR compared to low pCO2 treatments, and (3) calcification was not related to Omega Arag at BR. When normalized to NP, calcification was linearly related to Omega Arag at both sites, and the slopes of the relationships were not significantly different. The increase in NP at BR in the high pCO2 treatments may have increased calcification and thus masked the negative effect of low Omega Arag on calcification. Removing the effect of NP variations at BR showed that calcification declined in a similar manner with decreased Omega Arag (increased pCO2) whatever the nutrient loading.

Seawater carbonate chemistry and protein and chlorophyll a content per nubbin of Acropora muricata during observations of La Saline fringing reef, La Reunion Island, western Indian Ocean, 2011

The effect of decreasing aragonite saturation state (Omega Arag) of seawater (elevated pCO2) on calcification rates of Acropora muricata was studied using nubbins prepared from parent colonies located at two sites of La Saline reef (La Réunion Island, western Indian Ocean): a back-reef site (BR) affected by nutrient-enriched groundwater discharge (mainly nitrate), and a reef flat site (RF) with low terrigenous inputs. Protein and chlorophyll a content of the nubbins, as well as zooxanthellae abundance, were lower at RF than BR. Nubbins were incubated at ~27°C over 2 h under sunlight, in filtered seawater manipulated to get differing initial pCO2 (1,440-340 µatm), Omega Arag (1.4-4.0), and dissolved inorganic carbon (DIC) concentrations (2,100-1,850 µmol/kg). Increasing DIC concentrations at constant total alkalinity (AT) resulted in a decrease in Omega Arag and an increase in pCO2. AT at the beginning of the incubations was kept at a natural level of 2,193 ± 6 µmol/kg (mean ± SD). Net photosynthesis (NP) and calcification were calculated from changes in pH and AT during the incubations. Calcification decrease in response to doubling pCO2 relative to preindustrial level was 22% for RF nubbins. When normalized to surface area of the nubbins, (1) NP and calcification were higher at BR than RF, (2) NP increased in high pCO2 treatments at BR compared to low pCO2 treatments, and (3) calcification was not related to Omega Arag at BR. When normalized to NP, calcification was linearly related to Omega Arag at both sites, and the slopes of the relationships were not significantly different. The increase in NP at BR in the high pCO2 treatments may have increased calcification and thus masked the negative effect of low Omega Arag on calcification. Removing the effect of NP variations at BR showed that calcification declined in a similar manner with decreased Omega Arag (increased pCO2) whatever the nutrient loading.

Approach to the potential production of giant reed in surplus saline lands of Spain

Growing energy crops on marginal land has been promoted as a way of ensuring that biomass production involves an acceptable and sustainable use of land. Saline and saline-prone agricultural lands represent an opportunity for growing energy crops avoiding the displacement of food production and contributing to restoration of degraded land. Giant reed (Arundo donax L.) is a perennial grass that has been proposed as a promising energy crop for lignocellulosic biomass production while its tolerance to salinity has been proved. In this work, the identification of surplus saline lands that could be irrigated with saline waters for growing tolerant-energy crops (giant reed) in the mainland of Spain and the assessment of the agronomically attainable yield in these limiting growing conditions were undertaken. To this purpose, a GIS analysis was conducted using geodatabases related to saline areas, agro-climatic conditions, irrigation water requirements, agricultural land availability, restrictions regarding the range of electrical conductivity tolerated by the crop, competition with agro-food crops and irrigation water provisions. According to the approach developed, the irrigated and saline agricultural area available and suitable for biomass production from giant reed amounted up to 34 412 ha. The agronomically attainable yield in these limiting conditions was estimated at 12.7 – 22.2 t dm ha−1 yr−1 and the potential production of lignocellulosic biomass, 597 338 t dm yr−1. The methodology followed in this study can be applied to other target regions; it allows the identification of this type of marginal lands, where salinity-tolerant plant species could be grown for bioenergy purposes, avoiding competition with agro-food crops, and where soil restoration measurements should be undertaken.

Saline Stress Alters the Temporal Patterns of Xylem Differentiation and Alternative Oxidase Expression in Developing Soybean Roots1

We conducted a coordinated biochemical and morphometric analysis of the effect of saline conditions on the differentiation zone of developing soybean (Glycine max L.) roots. Between d 3 and d 14 for seedlings grown in control or NaCl-supplemented medium, we studied (a) the temporal evolution of the respiratory alternative oxidase (AOX) capacity in correlation with the expression and localization of AOX protein analyzed by tissue-print immunoblotting; (b) the temporal evolution and tissue localization of a peroxidase activity involved in lignification; and (c) the structural changes, visualized by light microscopy and quantified by image digitization. The results revealed that saline stress retards primary xylem differentiation. There is a corresponding delay in the temporal pattern of AOX expression, which is consistent with the xylem-specific localization of AOX protein and the idea that this enzyme is linked to xylem development. An NaCl-induced acceleration of the development of secondary xylem was also observed. However, the temporal pattern of a peroxidase activity localized in the primary and secondary xylem was unaltered by NaCl treatment. Thus, the NaCl-stressed root was specifically affected in the temporal patterns of AOX expression and xylem development.

A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants

OBJECTIVE: Acute bronchiolitis is a common disorder of infants that often results in hospitalization. Apart from supportive care, no therapy has been shown to influence the course of the disease, except for a possible effect of nebulized hypertonic saline (HS). To determine whether this does have beneficial effects on length of stay in hospital or on severity scores, we undertook a double-blind, randomized, controlled trial in a pediatric department of a Portuguese hospital. METHODS: Previously healthy infants, younger than 12 months, hospitalized with mild-to-moderate acute viral bronchiolitis were randomized to receive either nebulized 3% (hypertonic, HS) or 0.9% (normal, NS) saline during their entire hospital stay. Primary endpoints were: length of hospital stay and severity scores on each day of hospitalization. Need for supplemental oxygen, further add-on medications and adverse effects were also analyzed. RESULTS: Sixty-eight patients completed the study (HS: 33; NS: 35). The median length of hospital stay did not differ between groups: HS: 5.6 ± 2.3 days; NS: 5.4 ± 2.1 days (P = 0.747). We found no difference between groups in severity scores from day 1 to day 4. There were no differences in need for supplemental oxygen or add-on medications. Patients in HS group had significantly more cough (46% vs. 20%, P = 0.025) and rhinorrhoe (58% vs. 31%, P = 0.30). CONCLUSION: This study does not support the use of nebulized HS over NS in therapy of hospitalized children with mild-to-moderate acute viral bronchiolitis

Saline Township (Mich.) residences and business, ca. 1874

Left to right: Res. of Orange Risdon, Sec. 1, Saline Tp. Mich.; Res. of Andrew Bush, Sec. 3, Saline Tp. Mich.; Res. of Dudley Miller, Sec. 24, Saline Tp. Mich.; Saline Exchange, A. Harmon Prop, Saline, Mich.; Res. of Abram Davenport, Sec. 36, Saline Tp. Mich.; Res. of Milton Reynolds, Sec. 22, Saline Tp. Mich.; Res. of George Neissle, Sec. 12, Saline Tp. Mich.; Res. of Robert Hammond, Sec. 25, Saline Tp. Mich.; Res. of M. Himerdinger, Sec. 8, Saline Tp. Mich. Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Map of Saline Township. T.P. No. 4 S. Range No. 5 E [plat]

Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Saline Township (Mich.) residences, ca. 1874

Left to right: Res. of Robert Shaw, Sec. 24, Saline Tp. Mich.; Res. of Aaron L. Feldkamp, Sec. 7, Saline Tp. Mich.; Farm residence of A.K. Clark, Sec. 14, Saline Tp. Mich.; Res. of A.K. Clark, Sec. 1, Saline Village, Mich.; Res. of Harvey Bennett, Sec. 1, Saline Tp. Mich.; Res. of George Osborn, Sec. 35, Saline Tp. Mich. Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Saline & York Township (Mich.) residences and business, ca. 1874

Left to right: Res. of Henry A. Hammond, Sec. 26, Saline Tp. Mich.; Res. of Lewis Andrews, architect & builder, Saline, Mich.; Res. of E.C. Robinson, Saline Tp. Mich.; Res. of J.U. Fuller, Sec. 26 York Tp. Mich.; Res. of Daniel Aylsworth, Sec. 26, York Tp. Mich.; Res. of Wm. Dexter, Sec 26, York Tp. Mich.; Res. of Thos. H. Fuller, Sec. 24, York Tp. Mich. Publication information: Chicago, Ill. : Everts & Stewart, 1874.

York, Saline, Ypsilanti, Lyndon, Sharon (Mich.) Township residences, ca. 1874

Left to right: Res. of C. Parsons, Saline, Mich.; Res. of D.B. Green, Ypsilanti, Mich.; Res. of Justus Corwin, Sec. 17, York Tp. Mich.; Res. of Robert Howlett, Sec. 20, Lyndon Tp. Mich.; Res. of Wm. Basom, Sec. 2, York Tp. Mich.; Res. of Jay Everett, Sec. 2, sharon Tp. Mich. Publication information: Chicago, Ill. : Everts & Stewart, 1874.