Letters
Anatomy and physiology
Volume 190 - Issue 12

Avoiding common problems associated with intravenous fluid therapy

Authors:  Carlos D Scheinkestel, Andrew K Hilton and Vincent A Pellegrino

Med J Aust 2009; 190 (12): 718. || doi: 10.5694/j.1326-5377.2009.tb02657.x
Published online: 15 June 2009
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In reply: Franke presents some well known problems associated with intravenous administration of large volumes of 0.9% NaCl, particularly its relatively slow elimination (as compared with Hartmann’s solution), and hyperchloraemic acidosis.1 In isolation, we do not dispute these facts. However, 0.9% NaCl is not unique in having problems — no intravenous fluid therapy is without risk, especially when given in excessive volume, or when the composition is inappropriate for the patient’s needs.

It is also important to distinguish maintenance therapy from resuscitation. For postoperative maintenance therapy, we advocate a conservative approach with initial use of minimal volumes of isotonic fluids, to decrease the risk of common complications such as postoperative fluid retention, impaired respiratory function, and prolonged bowel dysmotility. We encourage close monitoring of volume and electrolyte status, and do not exclude the later use of hypotonic fluids.2

Disorders of volume and tonicity (hypo- or hypernatraemia) are the most common serious problems associated with intravenous fluid therapy. The approach we recommend follows the priorities of the kidney: restoration of volume, restoration of tonicity, and restoration of acid–base balance, in that order. If the patient’s requirements for fluid volume and tonicity are met, and tissue perfusion and gas exchange restored, then significant morbidity or death is unlikely to be a direct consequence of isolated 0.9% NaCl-induced hyperchloraemic acidosis.

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