How to select optimal maintenance intravenous fluid therapy

Hyponatraemia is the commonest electrolyte abnormality in hospitalized patients. If the plasma sodium concentration (P-Na) declines to similar to120 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.