The sodium conundrum. A conundrum is a riddle, a brain teaser, an enigma. So perhaps a better title for my talk would be: "The Riddle of Salts." I am Niels Van Regenmortel from Antwerp in Belgium and what I'm most passionate about in fluid management today is this: We should be doing much more to avoid excessive sodium administration in hospitalized patients. Why? Because sodium—not just fluid—is a major contributor to fluid overload in our patients. This issue goes beyond the volume of fluids we give—it's also about the sodium content of those fluids. So how can we reduce sodium overload? There are two key strategies: Use hypotonic maintenance solutions. We should avoid routine use of isotonic maintenance fluids, except in very specific cases, such as patients with brain edema, where sodium balance is critical. Avoid "fluid creep" and "salt creep." These are the hidden sources of sodium that come in through medications, flushes, and infusion carriers. They often go unnoticed but can significantly contribute to daily sodium load. Let's also remember that potassium often gets an unfair reputation. The normal dietary intake of potassium ranges from 40 to 120 mmol per day. People panic when serum potassium rises slightly above 5 mmol/L, but that's just what's circulating in the blood. In reality, our bodies are well adapted to much higher potassium intake. For example, a single glass of orange juice contains about 120 mmol of potassium. Finally, I'd like to emphasize the importance of this Congress. It fills a critical gap—because no other meeting is dedicated solely to fluids. And yet, fluid management is central to the care of every hospitalized patient. Every clinician, in every specialty, should be thinking carefully about how fluids—and particularly sodium—are being managed.

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