After establishing the new standard of care of isotonic fluids for maintenance therapy, there has not been a systematic follow-up to determine whether the goal of the switch has been achieved or whether there have been any unexpected complications with the change. This is a brief review of the history of maintenance intravenous fluids and potential complications of isotonic fluid therapy spurred by a case. This article is not meant to provide evidence or practical help in clinical decision making, but to provoke a reconsideration of what, when, and how much intravenous fluids should be administered. We report a case of a 16-year-old adolescent female admitted for evaluation and management of acute gastroenteritis. We have informed consent from the patient’s family to publish this case history. In the hospital, she was treated with resuscitation fluids and a maintenance infusion with normal saline. She was diagnosed with terminal ileitis secondary to enteropathogenic E. coli/Salmonella enterocolitis. She developed new-onset hypertension within three days of admission, with an electrocardiogram demonstrating evidence of a left ventricular strain pattern. Based on the current guidelines, isotonic fluids are the preferred maintenance fluids; as such, there has been widespread use of normal saline for maintenance. Utilization of normal saline may help prevent hyponatremia but may be at the expense of new complications such as hypernatremia, hypertension, and/or hypokalemia.

Intravenous fluids, Hypotonic, Isotonic, Hyponatremia