Table 1.

Considerations for Specific Types of Maintenance IV Fluid13.

Type of mIVF	Example(s)	Considerations
Isotonic saline	0.9% NaCl	Distributed throughout extracellular fluid compartment High Na+ content may promote Na+ and water retention Supraphysiologic Cl- content may promote hyperchloremia and development of hyperchloremic metabolic acidosis and renal dysfunction19–23 Not effective to alkalinize urine or plasma
Hypotonic salines	0.45% NaCl, 0.225% NaCl	Greater distribution to tissues compared to isotonic crystalloids Risk of hyponatremia
Hypertonic salines	3% NaCl	Less distribution to tissues compared with isotonic crystalloids Risk of hypernatremia Generally used in low volumes for sodium replacement or effects on tonicity, not fluid replacement
Dextrose solutions	D5W, D10W	Fluid distributed throughout total body water Glucose content prevents starvation ketosis Risk of hyponatremia Risk of hyperglycemia
Dextrose-containing crystalloids	D5NS, D5LR, D5½NS	Glucose content prevents starvation ketosis Risk of hyperglycemia Lower risk of hyponatremia compared to pure dextrose solutions
Balanced crystalloids	LR, PlasmaLyte	Distributed throughout extracellular fluid compartment Less risk of hyperchloremia compared to 0.9% NaCl Contains other electrolytes that may meet overall maintenance needs Contains 4–5 mEq/L of potassium Risk of lactate accumulation in advanced liver cirrhosis
NaHCO3	50–100 mEq in 1/2NS; 150 mEq in sterile water or D5W	Effective plasma and urine alkalinization Risk of metabolic alkalosis Consider patient specific factors when choosing diluent In patients at higher risk or currently hypervolemic, consider no diluent and adjust administration rate. May be helpful in AKI with pH<7.2024 or sepsis with pH<7.1525 When used in acidemia, overcorrection of pH may worsen end-organ perfusion26,27

Abbreviations: mIVF, maintenance intravenous fluid; NaCl, sodium chloride; D5W, 5% dextrose in water; D10W, 10% dextrose in water; D5NS, 5% dextrose in 0.9% NaCl; D5LR, 5% dextrose in lactated Ringer’s; D5½NS, 5% dextrose in 0.45% NaCl; LR, Lactated Ringer’s; D5LR, 5% dextrose in lactated Ringer’s.