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We commend Gottenborg and Pierce on their well-written summary of the 2013 National Institutes of Care Excellence (NICE) guidelines on int
The recommendations for hypotonic solutions were largely developed from theoretical research in the 1950s before the first description of the syndrome of inappropriate secretion of antidiuretic hormone.5 Hospitalized patients are at significant risk for nonosmotic stimuli for antidiuretic hormone secretion, and hypotonic fluids increase the risk of hyponatremia, which can have catastrophic complications. We believe the pediatric evidence should be extrapolated and included with the supporting (albeit limited) adult evidence, and that when indicated, isotonic fluids should be the maintenance fluid for most hospitalized adults.3-4,6
Disclosures
We have no relevant conflicts of interest to report. No payment or services from a third party were received for any aspect of this submitted work. We have no financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what was written in this submitted work.
1. Gottenborg E, Pierce R. Clinical Guideline Highlights for the Hospitalist: The Use of Intravenous Fluids in the Hospitalized Adult. J Hosp Med. 2019;14(3):172-173. https://doi.org/10.12788/jhm.3178
2. National Clinical Guideline Centre. Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital, London: Royal College of Physicians (UK); 2013 Dec. Updated May 3, 2017. https://www.nice.org.uk/guidance/g174. Accessed April 6, 2019.
3. Feld LG, Neuspiel DR, Foster BA, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142(6):170-171. https://doi.org/10.1542/peds.2018-3083.
4. Neilson J, O’Neill F, Dawoud D, Crean P, Guideline Development G. Intravenous fluids in children and young people: summary of NICE guidance. BMJ. 2015;351:h6388. https://doi.org/10.1136/bmj.h6388
5. Talbot NB, Crawford DJ, Butler AM. Medical progress; homeostatic limits to safe parenteral fluid therapy. N Engl J Med. 1953;248:1100-1108. https://doi.org/10.1056/NEJM195306252482605
6. Okada M, Egi M, Yokota Y, et al. Comparison of the incidences of hyponatremia in adult postoperative critically ill patients receiving intravenous maintenance fluids with 140 mmol/L or 35 mmol/L of sodium: retrospective before/after observational study. J Anesth. 2017;31(5):657-663 PubMed
We commend Gottenborg and Pierce on their well-written summary of the 2013 National Institutes of Care Excellence (NICE) guidelines on int
The recommendations for hypotonic solutions were largely developed from theoretical research in the 1950s before the first description of the syndrome of inappropriate secretion of antidiuretic hormone.5 Hospitalized patients are at significant risk for nonosmotic stimuli for antidiuretic hormone secretion, and hypotonic fluids increase the risk of hyponatremia, which can have catastrophic complications. We believe the pediatric evidence should be extrapolated and included with the supporting (albeit limited) adult evidence, and that when indicated, isotonic fluids should be the maintenance fluid for most hospitalized adults.3-4,6
Disclosures
We have no relevant conflicts of interest to report. No payment or services from a third party were received for any aspect of this submitted work. We have no financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what was written in this submitted work.
We commend Gottenborg and Pierce on their well-written summary of the 2013 National Institutes of Care Excellence (NICE) guidelines on int
The recommendations for hypotonic solutions were largely developed from theoretical research in the 1950s before the first description of the syndrome of inappropriate secretion of antidiuretic hormone.5 Hospitalized patients are at significant risk for nonosmotic stimuli for antidiuretic hormone secretion, and hypotonic fluids increase the risk of hyponatremia, which can have catastrophic complications. We believe the pediatric evidence should be extrapolated and included with the supporting (albeit limited) adult evidence, and that when indicated, isotonic fluids should be the maintenance fluid for most hospitalized adults.3-4,6
Disclosures
We have no relevant conflicts of interest to report. No payment or services from a third party were received for any aspect of this submitted work. We have no financial relationships with entities in the bio-medical arena that could be perceived to influence, or that give the appearance of potentially influencing, what was written in this submitted work.
1. Gottenborg E, Pierce R. Clinical Guideline Highlights for the Hospitalist: The Use of Intravenous Fluids in the Hospitalized Adult. J Hosp Med. 2019;14(3):172-173. https://doi.org/10.12788/jhm.3178
2. National Clinical Guideline Centre. Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital, London: Royal College of Physicians (UK); 2013 Dec. Updated May 3, 2017. https://www.nice.org.uk/guidance/g174. Accessed April 6, 2019.
3. Feld LG, Neuspiel DR, Foster BA, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142(6):170-171. https://doi.org/10.1542/peds.2018-3083.
4. Neilson J, O’Neill F, Dawoud D, Crean P, Guideline Development G. Intravenous fluids in children and young people: summary of NICE guidance. BMJ. 2015;351:h6388. https://doi.org/10.1136/bmj.h6388
5. Talbot NB, Crawford DJ, Butler AM. Medical progress; homeostatic limits to safe parenteral fluid therapy. N Engl J Med. 1953;248:1100-1108. https://doi.org/10.1056/NEJM195306252482605
6. Okada M, Egi M, Yokota Y, et al. Comparison of the incidences of hyponatremia in adult postoperative critically ill patients receiving intravenous maintenance fluids with 140 mmol/L or 35 mmol/L of sodium: retrospective before/after observational study. J Anesth. 2017;31(5):657-663 PubMed
1. Gottenborg E, Pierce R. Clinical Guideline Highlights for the Hospitalist: The Use of Intravenous Fluids in the Hospitalized Adult. J Hosp Med. 2019;14(3):172-173. https://doi.org/10.12788/jhm.3178
2. National Clinical Guideline Centre. Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital, London: Royal College of Physicians (UK); 2013 Dec. Updated May 3, 2017. https://www.nice.org.uk/guidance/g174. Accessed April 6, 2019.
3. Feld LG, Neuspiel DR, Foster BA, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142(6):170-171. https://doi.org/10.1542/peds.2018-3083.
4. Neilson J, O’Neill F, Dawoud D, Crean P, Guideline Development G. Intravenous fluids in children and young people: summary of NICE guidance. BMJ. 2015;351:h6388. https://doi.org/10.1136/bmj.h6388
5. Talbot NB, Crawford DJ, Butler AM. Medical progress; homeostatic limits to safe parenteral fluid therapy. N Engl J Med. 1953;248:1100-1108. https://doi.org/10.1056/NEJM195306252482605
6. Okada M, Egi M, Yokota Y, et al. Comparison of the incidences of hyponatremia in adult postoperative critically ill patients receiving intravenous maintenance fluids with 140 mmol/L or 35 mmol/L of sodium: retrospective before/after observational study. J Anesth. 2017;31(5):657-663 PubMed
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