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Rachel, I appreciate your comments. I agree about NS and hyhoecplerrmic acidosis. Somewhere deep in the DNA of all internists, is an aversion to Ringer's lactate. I think they may have been frightened by lactate when they were children. I have never used Hextend and am not aware of any good studies about it and renal failure. Since it is 6% hetastarch in RL, I would think it's similar 6% hetastarch in NS. That is assuming the starch is the culprit. A discredited researcher named Joachim Boldt wrote about it but he's had about 100 papers retracted. I don't think he would be a good source.