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October 3, 1977

Another Plea for Limiting Intravenous Infusions

Author Affiliations

Medical College of Pennsylvania and Hospital Philadelphia

JAMA. 1977;238(14):1503. doi:10.1001/jama.1977.03280150073030

To the Editor.—  The recent letter (237:1927, 1977) regarding "Ubiquitous (and Extravagant) Intravenous Infusion" certainly hits home for a neurosurgeon. We echo Viljoen's plea, especially in patients unable to eat, drink, or communicate after brain damage, but for another reason— aggravation of cerebral edema or even water intoxication.1 In the acute phase when vomiting is likely, intravenous infusion, of course, is the only route for replacement of excreted and secreted fluids. However, as we previously reported,2 when the volume for a 70-kg adult is limited to 1 liter/24 hours during the immediate postcraniotomy period, hemostasis as measured by serum sodium level and osmolality and BUN level is better maintained than with double that amount. It can be assumed in unconscious patients, particularly after trauma, that antidiuretic hormone activity is heightened and that they cannot afford to have their kidneys "thoroughly flushed throughout the hospital stay." This is in