Intravenous Fluid Management for NPO Patients

General Principles

The American Society of Anesthesiologists recommends isotonic balanced crystalloids, such as PlasmaLyte, Ringer's lactate, or Hartmann's solution, as the primary fluid for NPO patients to reduce the risk of hyperchloremic acidosis and acute kidney injury 1, 2
Isotonic balanced crystalloids have ionic compositions closer to normal plasma than 0.9% saline, reducing complications 1
Balanced crystalloids contain physiologic chloride levels, preventing hyperchloremic acidosis 1, 2

In pediatric NPO patients, isotonic fluids are strongly recommended over hypotonic solutions to prevent hospital-acquired hyponatremia 3
For acute brain injury patients, isotonic crystalloids are mandatory, as hypotonic solutions significantly increase mortality 2
In patients with high-output stoma or short bowel syndrome, 0.9% saline is specifically recommended for initial IV rehydration when marked dehydration is present 5, 6
For patients with nephrogenic diabetes insipidus, 5% dextrose in water is the fluid of choice, not isotonic saline 7

The European Society of Anaesthesiology recommends assessing for contraindications to isotonic fluids, such as hypernatremic dehydration from nephrogenic diabetes insipidus, and using 5% dextrose instead 7
The American College of Gastroenterology recommends using 0.9% saline for initial IV rehydration in patients with high-output stoma and dehydration 5, 6
The Society of Critical Care Medicine recommends using balanced isotonic crystalloids for general NPO maintenance 1, 2
The Pediatric Critical Care Society recommends using isotonic balanced crystalloids with dextrose if needed for pediatric patients 3, 4