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Hypotonic versus isotonic maintenance intravenous fluid therapy in hospitalized children: a systematic review

Carolyn E Beck1

  • 1Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada. carolyn.beck@sickkids.ca

Clinical Pediatrics
|October 24, 2007
PubMed

Insights

This review found limited evidence on whether hypotonic fluids increase acute hyponatremia risk in children. More research is needed to determine the best intravenous maintenance fluids for hospitalized pediatric patients.

Area of Science:

  • Pediatric Medicine
  • Nephrology
  • Clinical Research

Background:

  • Hospitalized children often receive intravenous (IV) maintenance fluids.
  • The choice between hypotonic and isotonic IV fluids is debated.
  • Acute hyponatremia is a potential complication of IV fluid therapy.

Purpose of the Study:

  • To systematically review evidence comparing hypotonic versus isotonic IV maintenance fluids in children.
  • To determine if hypotonic solutions elevate the risk of acute hyponatremia.

Main Methods:

  • Systematic review of studies comparing hypotonic and isotonic IV fluids.
  • Searches conducted in electronic databases and reference lists.
  • Inclusion of 3 observational studies after reviewing 283 abstracts and 55 full-text articles.

Main Results:

  • The included studies were observational and yielded inconclusive results.
  • Hypotonic fluid administration was not consistently linked to acute hyponatremia development.
  • Authors cautioned against routine hypotonic fluid use.

Conclusions:

  • Current evidence is insufficient to definitively link hypotonic fluids to increased hyponatremia risk in children.
  • Further high-quality research is necessary.
  • Optimal IV maintenance fluid composition for hospitalized children remains undetermined.

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