Title: Too much salt may NOT be sweet.
题目：太多的盐可能并不好 （生理盐水在复苏中的作用）
Author 作者: Haney Mallemat

Previous pearls have described the increasing evidence against colloid (e.g., hydroxyethyl starch) use during resuscitation. Now it appears that the crystalloid 0.9% normal saline (NS) may be under fire. 
在前面的必知里介绍了没有证据支持胶体液（羟乙基淀粉液，HES）在液体复苏中的作用。现在看来，晶体液（0.9％生理盐水，NS）的应用也有下降趋势。
The use of large volumes of NS has been associated with hyperchloremic metabolic acidosis and harm in animal studies. The risk of harm in humans, however, has been less clear. 
动物实验显示，大量NS的使用与高氯性代谢性酸中毒有关，并造成危害。但是，它对人的有害作用还不清楚。
Bellomo et al. conducted a prospective observational study in which patients being resuscitated in the control group received NS at the clinicians' discretion; i.e., chloride-liberal strategy. The use of NS was restricted in the intervention group, where other less chloride containing fluids were used for resuscitation (e.g., Ringer's Lactate); i.e., a chloride-restrictive strategy. 
Bellomo等进行了一个前瞻性观察研究，对照组的病人根据病情的需要接受NS（氯随意方案）；治疗组的病人接受含氯浓度低的复苏液（乳酸林格液，氯限制方案）。
The authors found that when compared to patients in the chloride-liberal group, the chloride-restrictive group had significantly less rise in baseline creatinine, less overall AKI, and a reduced need for renal replacement therapy.
作者发现，与氯随意方案组病人比，氯限制组病人的基础肌酐增加明显减低，急性肾损伤发生率和对肾替代治疗的需要也有所减低，
Bottom line: Although this was only an observational study, the liberal use of normal saline during resuscitation may increase the risk of AKI and renal replacement therapy. 
要点：虽然这只是一个观察性报告，但它提示在液体复苏时NS的大量应用，会增加急性肾损伤和肾替代治疗的危险性。
References 参考文献

Bellomo, R. et al. Association between a chloride-liberal vs. chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012 Oct 17;308(15):1566-72. doi: 10.1001/jama.2012.13356.