Effect of Saline versus Gluconate/Acetate-Buffered Solution versus Lactate-Buffered Solution on Serum Chloride Among Children

Q: How was the study designed and what were the groups?

A prospective observational study included pediatric inpatients aged 1 month to 12 years, grouped into three cohorts: saline (n=30), gluconate/acetate-buffered (n=30), and lactate-buffered (n=30), with serum chloride measured at baseline and after 24 hours.

Q: What were the main findings regarding serum chloride levels?

Mean post-infusion chloride levels were significantly higher with saline (107.2 ± 3.1 mmol/L) than with gluconate/acetate-buffered (103.5 ± 2.4 mmol/L) and lactate-buffered (102.9 ± 2.8 mmol/L), with trends toward mild acidosis in the saline group.

Sep 30, 2026

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Intravenous fluid administration is routine in pediatric care, yet fluid composition can alter serum electrolyte levels. Hyperchloremia is often linked with 0.9% saline and may contribute to metabolic acidosis and renal dysfunction. This prospective observational study compared saline, gluconate/acetate-buffered, and lactate-buffered IV fluids in hospitalized children, measuring serum chloride at baseline and after 24 hours. Analysis used ANOVA and paired t-tests. Saline produced the highest post-infusion chloride and greater chloride elevation trends toward mild acidosis. Buffered solutions may better maintain electrolyte stability.

LanguageEnglish

CategoryHealthcare

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Pages3

Reading Time8 min

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Abstract

Introduction

Materials and Methods

Results

Original Article Effect of Saline versus Gluconate/Acetate‑Buffered Solution versus Lactate‑Buffered Solution on Serum Chloride Among Children Yunus Nadeemulla Beig Khader1, Sana Mehek2, Shubhanshu Gupta3 1Department of Pediatrics, Amana Healthcare, Al Ain, UAE, 2Department of Pediatrics, NMC Medical Centre, Sharjah, UAE, 3Department of Community Medicine, Government Medical College, Datia, Madhya Pradesh, India Submitted: 10‑Jul‑2025 Revised: 25‑Jul‑2025 Accepted: 03‑Aug‑2025 Published: 17‑Dec‑2025 Abstract Background: Intravenous (IV) fluid administration is routine in pediatric care, but fluid composition can significantly influence serum electrolyte levels. Hyperchloremia, often associated with 0.9% saline, may lead to metabolic acidosisand renal dysfunction. Balanced solutions, including gluconate/acetate-buffered and lactate-buffered fluids, are being explored for safer alternatives. Objective: To compare the effects of saline, gluconate/acetate-buffered, and lactate-buffered IV fluids on serum chloride levels in hospitalized children. Materials and Methods: A prospective observational study was conducted among pediatric in patients receiving one of three IV fluids: saline (n = 30), gluconate/acetate-buffered solution (n = 30), or lactate-buffered solution (n = 30) . Serum chloride was measured at baseline and after 24 h of fluid administration. Statistical analysis was performed using ANOVA and paired t‑tests. Results: Mean post‑infusion chloride levels were significantly higher in the saline group (107.2 ± 3.1 mmol/L) compared to the gluconate/acetate group (103.5 ± 2.4 mmol/L) and lactate-buffered group (102.9 ± 2.8 mmol/L) (P < 0.001) . Chloride elevation was most pronounced in the saline group, with associated trends toward mild acidosis. Conclusion: Saline use in children is associated with greater increases in serum chloride compared to balanced solutions. Buffered fluids may be preferable for maintaining electrolyte stability in pediatric fluid therapy. Keywords: Gluconate/acetate‑buffered, hyperchloremia, lactate‑buffered solution, pediatric IV fluids, saline, serum chloride Introduction Intravenous fluid pediatric inpatient therapy is a cornerstone of care for hydration, electrolyte balance, and metabolic support.[1] However, isotonic saline (0.9% NaCl), though commonly used, contains a supraphysiological chloride concentration that may contribute to hyperchloremia and metabolic acidosisin children. Emerging evidence has prompted a shift toward more physiologically balanced fluids, such as gluconate/acetate-buffered and lactate-buffered solutions, which may better preserve acid‑base and electrolyte equilibrium.[2,3] These fluids differ in their buffer content and metabolism, potentially influencing serum chloride levels and related clinical outcomes. While adult data support the use of buffered fluids, pediatric studies remain limited.[4,5] This study was conducted to | Access this article online | | | --- | --- | | Quick Response Code:
| Website: [https://journals.lww.com/jpbs](https://journals.lww.com/jpbs) | | | DOI: 10.4103/jpbs.jpbs_1208_25 | compare the effects of saline, gluconate/acetate-buffered, and lactate-buffered IV fluids on serum chloride concentrations among hospitalized children. Materials and Methods This prospective observational study was conducted among pediatric inpatients aged 1 month to 12 years who required intravenous fluid therapy for at least 24 h. Patients were grouped based on the type of IV fluid received: Group A (0.9% saline, n = 30), Group B (gluconate/acetate-buffered solution, n = 30), and Group C (lactate-buffered solution, n = 30) . | Address for correspondence: Dr. Yunus Nadeemulla Beig Khader, Amana Healthcare, Al Ain, UAE. E‑mail: [ynb79@yahoo.co.in](ynb79@yahoo.co.in) | | --- | | This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC

FAQs

What is the primary objective of the study?

To compare the effects of saline, gluconate/acetate-buffered, and lactate-buffered IV fluids on serum chloride levels in hospitalized children.

How was the study designed and what were the groups?

A prospective observational study included pediatric inpatients aged 1 month to 12 years, grouped into three cohorts: saline (n=30), gluconate/acetate-buffered (n=30), and lactate-buffered (n=30), with serum chloride measured at baseline and after 24 hours.

What were the main findings regarding serum chloride levels?

Mean post-infusion chloride levels were significantly higher with saline (107.2 ± 3.1 mmol/L) than with gluconate/acetate-buffered (103.5 ± 2.4 mmol/L) and lactate-buffered (102.9 ± 2.8 mmol/L), with trends toward mild acidosis in the saline group.

Sep 30, 2026

Uploaded by SANS