Hypertonic solution cautions/contraindications: which statement is true?

• A. Not maintenance fluid
• B. Not for poor ICF volume
• C. Not replacement for isotonic crystalloids
• D. All of the above

Answer: (D)

Hypertonic solutions pull water out of the cells into the extracellular space, which is why they can rapidly expand circulating volume but also carry specific cautions. They’re not used as maintenance fluids because their high osmolality can quickly raise sodium and serum osmolality, risking dehydration and electrolyte imbalances with routine use. If intracellular fluid volume is low, a hypertonic solution would draw water out of cells and worsen intracellular dehydration, so it’s not appropriate when ICF depletion is the primary issue. And for general resuscitation, hypertonic solutions do not replace isotonic crystalloids; isotonic fluids are typically used to restore intravascular volume, with hypertonic solutions reserved for particular situations and usually in combination with isotonic fluids. So all of these cautions are correct.