Podcast 833: NS vs LR - The Emergency Medical Minute

Podcast 833: NS vs LR

Contributor: Travis Barlock, MD

Educational Pearls:

  • Normal Saline (NS) contains 154 mEq of both Sodium (Na) and Chloride (Cl),  and has a pH of 5.5
    • Normal Na and Cl in adult humans are about 140 mEq/L and 103 mEq/L. respectively 
  •  Excess negative charge resulting from hyperchloremia is managed via bicarbonate excretion leading to loss of base
    • Overall, administration of NS drives metabolic acidosis
  • Lactated Ringers (LR) contains 130 mEq of Na and 109 mEq Cl, and has a pH of 6.5  
  • LR components are closer to physiologic levels thus may generally be a more efficacious fluid choice  
  • NS is still frequently given in scenarios where there is concern for increased intracranial pressure or existing hypochloremic alkalosis from emesis. 

Li H, Sun SR, Yap JQ, Chen JH, Qian Q. 0.9% saline is neither normal nor physiological. J Zhejiang Univ Sci B. 2016;17(3):181-187. doi:10.1631/jzus.B1500201

​​Lehr AR, Rached-d’Astous S, Barrowman N, et al. Balanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis. Pediatr Crit Care Med. 2022;23(3):181-191. doi:10.1097/PCC.0000000000002890

Self WH, Semler MW, Wanderer JP, et al. Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials. 2017;18(1):178. Published 2017 Apr 13. doi:10.1186/s13063-017-1923-6

Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584

Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD


In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/

Donate to EMM today!


Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.


Stay up to date by
joining our mailing list!