Is normal saline solution the best crystalloid for intravascular volume resuscitation?

Abstract

A 30-year-old male with no significant past medical history presents to the emergency room with complaints of severe abdominal pain. The patient reports that the pain began 2 days ago. It has since migrated to the right lower quadrant. Associated symptoms include nausea without vomiting, anorexia, and a subjective fever. Significant vital signs include a temperature of 103.4°F, a heart rate of 110 beats per minute, and a blood pressure of 80/50. Physical examination reveals a diffusely tender abdomen with guarding and rebound tenderness. Pertinent preoperative laboratories include a WBC of 22,000 cells/µ(mu)L and a lactate level of 5.8 mmol/L. An abdominal computed tomography (CT) scan confirms the suspected diagnosis of perforated appendicitis. The general surgery service is consulted and the chief resident recommends IV antibiotics and emergent laparotomy for appendectomy and irrigation and drainage of the peritoneal cavity.