Hypotonic maintenance i.v. fluids are not appropriate in acutely ill patients. Conclusions can't be extrapolated from healthy volunteers

Editor—A critical aspect in the care of acutely ill patients is the administration of i.v. fluids.¹ Debate exists in the both pediatric and adult literature regarding the optimal sodium composition of i.v. fluids. Our group has advocated for the use of an isotonic solution, such as 0.9% NaCl (154 mEq litre⁻¹), for the prevention of hospital-acquired hyponatraemia, as hypotonic solutions have been associated with a high incidence of hospital-acquired hyponatraemia and neurologic complications in both children and adults.^2–5 Acutely ill patients have numerous physiological and disease related stimuli for vasopressin (AVP) production, which makes virtually all hospitalized patients at risk for hyponatraemia.¹ Concerns against the use of 0.9% NaCl are the potential for developing hypernatraemia, fluid overload and hyperchloraemic acidosis.

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