Intravenous Fluids in Hospitalized Patients: A Review of Best Practices

Judicious use of intravenous fluids in hospitalized patients can improve outcomes and prevent adverse events. For many clinical scenarios, balanced crystalloids have some advantages over normal saline, though the differences in outcomes are small. Excessive administration of normal saline can cause metabolic acidosis and kidney injury. For conditions with sodium and/or chloride deficits, normal saline is preferred. Hypertonic saline is used to rapidly correct severe acute hyponatremia, and hypotonic fluids are indicated for replacement of free water deficits. Intravenous albumin is indicated in only specific scenarios in the setting of cirrhosis and does not seem to have significant advantages for routine volume resuscitation over crystalloids. When intravenous fluids are administered, patient response should be closely monitored to guide subsequent therapy.