Fluid
resuscitation in the
critically ill is a hot topic. The current strategy of rapid and adequate
resuscitation in
shock followed by conservative fluid administration is often difficult to achieve with standard
crystalloid solutions. Research into alternative intravenous fluids tailored to individual patient needs is required. In the previous issue of
Critical Care, Somasetia and colleagues compare the effects of hypertonic
sodium lactate with the World Health Organization-recommended strategy of
Ringer's lactate resuscitation in children with
severe Dengue, a
viral infection for which causal treatment and vaccination are not available. The results not only suggest unimpaired
lactate metabolism during
shock in children but document improvement in endothelial barrier function, limited coagulopathy, and avoidance of fluid overload with hypertonic
sodium lactate. Their study invites several important questions to be answered. Is hypertonicity or
lactate per se important for the beneficial effects? Are the metabolic or anti-inflammatory effects responsible? Is the raised
lactate in
shock an adaptive response? Should reduction in
lactate levels be the goal of
resuscitation? These questions may trigger further research into the role of
lactate and
lactate-based intravenous fluids in
resuscitation of the
critically ill.