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Q J Med 2003; 96: 601-610
© 2003 Association of Physicians

Commentary

How to select optimal maintenance intravenous fluid therapy

M.A.S. Shafiee1, D. Bohn2, E.J. Hoorn2 and M.L Halperin1

From the 1Renal Division, St. Michael’s Hospital, University of Toronto, and 2Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada and the Department of Anaesthesiology, University of Toronto, Toronto, Canada

Hyponatraemia is the commonest electrolyte abnormality in hospitalized patients. If the plasma sodium concentration (PNa) declines to ~120 mM in <48 h, brain cell swelling might result in herniation, with devastating consequences. The volume and/or the composition of fluids used for intravenous therapy often contribute to the development of acute hyponatraemia. Our hypothesis is that the traditional calculation of the daily loss of insensible water overestimates this parameter, leading to an excessive daily recommended requirement for water. We offer suggestions to minimize the risk of iatrogenic hyponatraemia.

Address correspondence to: Professor M.L. Halperin, Division of Nephrology, St. Michael’s Hospital Annex, 38 Shuter Street, Toronto, Ontario, Canada, M5B 1A6. e-mail: mitchell.halperin{at}utoronto.ca


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