IV Maintenance fluids for sick children: what fluid, and how much? This seemingly simple question has a controversial, complex and evolving answer. Long-held traditions of giving hypotonic intravenous fluids to children have been increasingly challenged, due to dangerous adverse effects.
In this episode, we look at a few papers to address the hypotonic fluid controversy.
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IV Maintenance fluids for sick children: what fluid, and how much?
(CP) 1957 Holliday & Segar: The maintenance need for water in parenteral fluid therapy. [Pediatrics 1957; 19: 823-832]
(SF) 2003 Moritz: Prevention of hospital-acquired hyponatraemia: a case for using isotonic saline. [Pediatrics 2003; 111: 227-30]
(KB) 2003 Duke: Intravenous fluids for seriously ill children: time to reconsider. [The Lancet 2003; 362: 1320-23]
(CP) 2004 Hoorn: Acute hyponatraemia related to intravenous fluid administration in hospitalised children: an observational study. [Pediatrics 2004; 113: 1279-84]
(MB) 2005 Holliday: Isotonic saline expands extracellular fluid and is inappropriate for maintenance therapy. [Pediatrics 2005; 115: 193-194]
(SF) 2007 Holliday: Fluid therapy for children: facts, fashions and questions. [Archives of Disease in Childhood 2007; 92: 546-550]
(KB) 2009 Yung: Randomised controlled trial of intravenous maintenance fluids. [Journal of Paediatrics and Child Health 2009; 45: 9-14]
(MB) 2010 Neville: Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomised study of fluid type versus fluid rate. [The Journal of Pediatrics 2010; 156: 313-9]
(CP) – JHC changed (several years ago) to N/Saline + 5% dextrose for under 5yrs, N/Saline over 5yrs
Manufactured ready-made [N/saline +5% DW] available, but only as 1 litre bags: use a burette!
Can make your own – safer to add sugar to N/Saline than adding Sodium to 5% dextrose
(remove 50mL from a 500mL bag of Normal Saline, add 50mL of 50% dextrose, ie 25g in 500mL = 5% dextrose)
Inertia, slow changes on wards but improving…
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