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Randomised controlled trial of intravenous maintenance fluids

Michael Yung1, Steve Keeley

  • 1Paediatric Intensive Care Unit, Women's and Children's Hospital, South Australia, Australia. michael.yung@cywhs.sa.gov.au

Journal of Paediatrics and Child Health
|November 27, 2007
PubMed

Insights

Dextrose saline intravenous fluids increase the risk of hyponatraemia (low sodium) in sick children compared to normal saline. Traditional fluid rates also contributed to sodium decrease in pediatric intensive care patients.

Area of Science:

  • Pediatric Intensive Care Medicine
  • Clinical Chemistry
  • Fluid and Electrolyte Management

Background:

  • Traditional pediatric intravenous maintenance fluids often use hypotonic solutions and the 4:2:1 weight-based formula.
  • This standard practice may lead to hyponatraemia in critically ill and post-operative children.
  • Understanding fluid type and rate effects on sodium is crucial for patient safety.

Purpose of the Study:

  • To investigate the impact of different intravenous fluid types and administration rates on plasma sodium concentration in pediatric intensive care patients.
  • To compare the effects of normal saline versus dextrose saline solutions.
  • To evaluate the influence of traditional versus restricted fluid administration rates.

Main Methods:

  • A factorial-design, double-blind, randomized controlled trial involving 50 pediatric intensive care patients.
  • Patients received either 0.9% saline (normal saline) or 4% dextrose and 0.18% saline (dextrose saline).
  • Fluid administration was at either the traditional maintenance rate or two-thirds of that rate, with plasma sodium change measured over 12-24 hours.

Main Results:

  • Plasma sodium levels decreased in all patient groups, with a mean fall of 2.3 mmol/L.
  • Fluid type significantly impacted sodium levels (P=0.0063), with dextrose saline causing a greater reduction than normal saline.
  • Administration rate did not show a significant association with sodium changes (P=0.12).

Conclusions:

  • Dextrose saline, when administered at traditional maintenance rates, poses a significant risk of hyponatraemia in sick and post-operative pediatric patients.
  • Careful consideration of intravenous fluid composition is essential to prevent electrolyte disturbances in vulnerable pediatric populations.
  • Further research may explore optimized fluid strategies for pediatric intensive care settings.
Abstract

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