The Dose Makes the Poison

IV fluid therapy is ubiquitous in hospitals. It is part of any patient’s admission orders, either as resuscitation therapy for patients receiving emergency or postoperative care and patients with sepsis or as maintenance therapy for patients with compromised oral intake; alternatively, IV fluid may be used as the diluent for most parenteral medications administered to patients. IV fluids are not usually purchased or stocked by the department of pharmacy, and we hospital pharmacists often do not view them as medications, with a dose–response relationship, or as a cause of potential harm to our patients. Despite the guidelines of the UK National Institute for Health and Care Excellence (published in 2013 and updated in 2017),1 which outline general principles for managing IV fluids, they continue to be poorly prescribed overall.2,3 The time has come that we pharmacists change our mindset about fluids and start considering this form of therapy as we would any other medication, that is, a treatment requiring individualization and proper monitoring