Isotonic saline - the only solution to recommend?

addressing controversies regarding colloid solution carrier fl uids [1]. Instead of off ering a balanced view, however, the article focused on the refutation of dilutional hyperchloraemic acidosis, depicting it as a clinically innocent inevitability we should accept rather than try to avoid. Th e authors initially forward the view that ‘unless recommendations are based on high quality primary research ... clinicians would be better off making clinical decisions on the basis of primary data’ – just to end doing the opposite by recommending against the use of balanced colloid solutions based on ‘limited published information’ [1]. To the best of my knowledge there are no published data suggesting adverse eff ects of balanced solutions compared with isotonic saline, yet there remains the (non?)issue of hyperchloraemic acidosis. Sound judge ment suggests that if a clinical uncertainty can be avoided without suggestion of doing harm, then a clinician may expect to be allowed the freedom of making such a choice. Th e conclusion this review should have is the one it begins with – the informed clinician should be left to make the decision in which patients to use a balanced colloid and in which to use an isotonic saline-based solution, until evidence for clear benefi t or harm can be demonstrated, as recently suggested by one of the authors herself [2]. Since no data suggestive of balanced colloid being inferior to saline-based solutions are presented, it seems unusual to forward opinions dismissive of existing noninferiority evidence since non-inferiority trials have become the mainstay for introducing new drugs [3].