Balanced Salt Solution Versus Ringer Lactate in Emergency Laparotomy: A Prospective Randomized Study of Acid-Base and Electrolyte Outcomes

Background Emergency laparotomy is associated with significant physiological derangements, where optimal fluid therapy plays a crucial role in maintaining acid-base balance and electrolyte homeostasis. The choice of intraoperative crystalloid may influence perioperative outcomes. Objectives To compare the efficacy and safety of balanced salt solution (BSS) and Ringer lactate (RL) on acid-base status and electrolyte profile in patients undergoing emergency laparotomy. Methods This prospective randomized study was conducted at a tertiary care center and included 60 patients with intestinal obstruction or perforation undergoing emergency laparotomy. Patients were randomly allocated into two groups to receive either BSS or RL as intraoperative maintenance fluid. Arterial blood gas parameters and serum electrolytes were assessed perioperatively and compared between the groups. Results BSS was associated with a more stable acid-base profile, with higher pH and bicarbonate levels compared to RL. Serum sodium levels were mildly higher in the BSS group, while potassium levels were higher in the RL group. Chloride levels remained comparable between the groups. Serum calcium levels were significantly higher in the BSS group. Lactate levels decreased in the BSS group but increased significantly in the RL group. Serum osmolarity remained within normal limits in both groups. Conclusion BSS demonstrated superior maintenance of acid-base balance and electrolyte stability compared to RL in patients undergoing emergency laparotomy. Its use may contribute to improved perioperative metabolic outcomes.