N Engl J Med

Hospital-wide switch to lactated Ringer’s fails to reduce death or readmission

July 8, 2025

A hospital-wide switch from normal saline (NS) to lactated Ringer’s (LR) didn’t significantly affect mortality or readmission rates, suggesting that, for general hospitalized populations, either fluid may be reasonable.

Study details: This multicenter, cluster-randomized crossover trial compared hospital-wide use of LR vs. NS for IV fluid therapy. Conducted across 16 hospitals in Ontario, Canada, the study included over 150,000 adult patients admitted to the ED or hospital wards. Each hospital alternated between LR and NS every 12 weeks over a 52-week period.

Results: Among seven hospitals that completed both treatment periods before COVID-19 interrupted the trial, the 90-day rate of death or hospital readmission was slightly lower with LR than with NS (20.3% vs. 21.4%; 95% confidence interval, -1.85 to 0.79; P = 0.35). ). However, the adjusted difference wasn't statistically significant. Secondary outcomes aligned with the primary result, and no serious adverse events were reported.

Source:

McIntyre L, et al; Canadian Critical Care Trials Group. (2025, June 12). N Engl J Med. A Crossover Trial of Hospital-Wide Lactated Ringer's Solution versus Normal Saline. https://pubmed.ncbi.nlm.nih.gov/40503714/