A randomized, double blinded, pilot trial to compare the safety and efficacy of sodium chloride and sodium acetate combination intravenous fluids in acute stroke patients

Background and purpose Hyperchloremia in acute stroke patients is independently associated with increased rates of death or disability. We aim to compare the effects of a balanced intravenous (IV) fluid composed of 0.9% sodium chloride (NaCl) and sodium acetate (NaOAc) versus standard 0.9% NaCl on serum chloride (Cl) levels and safety outcomes in patients with acute stroke. Patients and methods Eighty acute stroke patients (64 ischemic stroke, 16 intracerebral hemorrhages) were randomized within 24 h of onset to one of four IV fluid regimens for 72 h: (1) NaCl 0.9%; (2) NaCl:NaOAc 3:1; (3)2:1; (4)1:1. Serum Cl and creatinine were monitored; safety events were adjudicated independently. Outcomes included 30- and 90-day modified Rankin Scale (mRS) scores. Results Groups 2–4 had significantly lower mean serum Cl versus group 1 at day 1 (P = 0.013) and day 2 (P = 0.014), with the lowest Cl in group 4 (1:1 ratio), with no safety concerns. No patient developed acute kidney injury (creatinine > 1.5 mg/dL). One serious adverse event was possibly treatment related. The 2:1 ratio group had the highest proportion of patients achieving mRS 0–2 at 30/90 days. Conclusion IV NaCl–NaOAc combination fluids effectively reduced serum Cl concentrations in a dose-dependent manner compared with IV NaCl alone, without an associated increase in safety events among acute stroke patients.