Brems JH, Casey JD, Wang L, et al. - Researchers undertook this secondary analysis of the Isotonic Solutions and Major Adverse Renal Events Trial, to ascertain whether improved results in critically ill adults admitted with low plasma bicarbonate could be achieved with balanced crystalloids vs saline. Participants visited Emergency Department with a first measured plasma bicarbonate less than 20 mmol/L. The primary outcome was major adverse kidney events within 30 days (MAKE30), defined as a composite of death, new renal-replacement therapy, or persistent renal dysfunction (final inpatient creatinine ≥ 200% baseline). Experts found that incidence of MAKE30 did not differ between participants assigned to balanced crystalloid vs saline. Based on the findings, initial plasma bicarbonate levels did not seem to be a beneficial indicator to guide the selection of balanced crystalloid vs saline in critically ill adults presenting to the Emergency Department.