ReviewAnnals of intensive care2021
Fluid-induced harm in the hospital: look beyond volume and start considering sodium. From physiology towards recommendations for daily practice in hospitalized adults.
Review in Annals of intensive care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 15 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Plasma Sodium and Sodium Administration in the ICU. A Retrospective Observational Study.
Effect of Reduced Sodium Chloride in Fluid Creep and Maintenance Fluids in Critically Ill Adults: A Randomized Controlled Trial
Who cites it
15 citing papers in PubMed, 44 citations in OpenAlex.
- Intraoperative isotonic balanced versus hypotonic crystalloids on postoperative sodium homeostasis in small children undergoing major neurosurgery: a randomized controlled trial.BMC pediatrics · 2025Trial
- Restrictive versus standard hyperhydration during high-dose cyclophosphamide for hematopoietic stem cell transplantation: a retrospective cohort study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Unnecessary fluid therapy in patients with shock: Five classic fluid pitfalls and five ways to do it better.Annals of intensive care · 2026Review
- Fluid Creep as an Independent Predictor of Fluid Overload and Mortality in Critically Ill Patients: A Cohort Study.Life (Basel, Switzerland) · 2025Article
- Free water improves sodium mobilization in furosemide treated pigs after a hyperosmotic sodium load.Intensive care medicine experimental · 2025Article
- Effects of different sodium concentrations in fluids on brain, lung, and kidney in experimental ischemic stroke.Scientific reports · 2025Article
- Sodium and chloride disturbances in critically ill adult patients: A protocol for a sub-study of the FLUID-ICU cohort study.Acta anaesthesiologica Scandinavica · 2025Article
- The Correlation of Fluid Creep with Fluid and Electrolyte Imbalance In Pediatric Intensive Care Unit Dr. Cipto Mangunkusumo National Central Public Hospital.Turkish archives of pediatrics · 2024Article
- Fluid dynamics of life: exploring the physiology and importance of water in the critical illness.Frontiers in medicine · 2024Review
- Effect of controlled hypotensive hemorrhage on plasma sodium levels in anesthetized pigs: An exploratory study.Physiological reports · 2023Article
- Role of Crystalloids in the Perioperative Setting: From Basics to Clinical Applications and Enhanced Recovery Protocols.Journal of clinical medicine · 2023Review
- Article
- Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review.Annals of intensive care · 2022Review
- Intravenous Fluid Administration and the Risk of Adverse Outcomes in Sickle Cell Disease Patients Hospitalized for Vaso-Occlusive Crisis.Journal of hematology · 2022Review
- Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.Annals of intensive care · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 8 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIatrogenic fluid overload is a potential side effect of intravenous fluid therapy in the hospital. Little attention has been paid to sodium administration as a separate cause of harm. With this narrative review, we aim to substantiate the hypothesis that a considerable amount of fluid-induced harm is caused not only by fluid volume, but also by the sodium that is administered to hospitalized patients.
methodsWe show how a regular dietary sodium intake is easily surpassed by the substantial amounts of sodium that are administered during typical hospital stays. The most significant sodium burdens are caused by isotonic maintenance fluid therapy and by fluid creep, defined as the large volume unintentionally administered to patients in the form of dissolved medication. In a section on physiology, we elaborate on the limited renal handling of an acute sodium load. We demonstrate how the subsequent retention of water is an energy-demanding, catabolic process and how free water is needed to excrete large burdens of sodium. We quantify the effect size of sodium-induced fluid retention and discuss its potential clinical impact. Finally, we propose preventive measures, discuss the benefits and risks of low-sodium maintenance fluid therapy, and explore options for reducing the amount of sodium caused by fluid creep.
conclusionThe sodium burdens caused by isotonic maintenance fluids and fluid creep are responsible for an additional and avoidable derailment of fluid balance, with presumed clinical consequences. Moreover, the handling of sodium overload is characterized by increased catabolism. Easy and effective measures for reducing sodium load and fluid retention include choosing a hypotonic rather than isotonic maintenance fluid strategy (or avoiding these fluids when enough free water is provided through other sources) and dissolving as many medications as possible in glucose 5%.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.