title: The history of 0.9% saline.
abstract: OBJECTIVE
  We aimed to trace the historical origins of 0.9% saline, how it came to be used so commonly today, and to consider whether its continued use can be justified.
  
  
  METHODS
  We searched the Medline, Science Citation Index, ScienceDirect and Google databases using the key words saline, physiological, salt solution, sodium chloride, 0.9%, intravenous, injection, fluid, cholera, resuscitation, parenteral, history, historical and origins.
  
  
  RESULTS
  The use of 0.9% saline is believed to have originated during the cholera pandemic that swept across Europe in 1831. However, an examination of the composition of the fluids used by the pioneering physicians of that era reveals solutions that bear no resemblance to 0.9% or so-called 'normal' saline which appears to have very little scientific or historical basis for its routine use, except for Hamburger's in vitro studies of red cell lysis.
  
  
  CONCLUSIONS
  The currently used 0.9% saline solution is without convincing historical basis. Given that the composition of 0.9% sodium chloride is dissimilar to most solutions used in the past, and is in no way 'normal' or 'physiological', our current practice may be based on historical fallacy and misconception.
authors.affiliation: Division of Gastrointestinal Surgery, Wolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: Sherif
authors.initials: S
authors.lastname: Awad
authors.forename: Simon P
authors.initials: SP
authors.lastname: Allison
authors.forename: Dileep N
authors.initials: DN
authors.lastname: Lobo
mesh_terms: D000075202:Contraindications; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions; D012151:Resuscitation; D012462:Saline Solution, Hypertonic / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic