Effect of isotonic vs hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers. Reply from the authors

Editor—We read with interest the comments by Leroy & Hoorn¹ and Moritz & Ayus,² mainly focusing on the occurrence of hyponatraemia after the use of hypotonic maintenance solutions, an association extensively demonstrated in paediatric populations. First and foremost, we set out to investigate whether, how and how much fluid retention could be induced by isotonic compared with hypotonic maintenance fluid therapy.³ All prior studies systematically neglected this potential side-effect. Although the clinical impact remains to be judged in dedicated trials, fluid retention of the magnitude we observed will not be regarded as trivial by most physicians dealing with postoperative or critical care patients.^4–7 The effect size after being exposed to salt-rich solutions for more than 48 h, as frequently encountered in clinical practice, can be expected to be even more substantial. There is no reason to suppose that our findings on fluid retention would be different in a situation of non-osmotic stimulation of antidiuretic hormone (ADH).

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