Intravenous fluid regimen and hyponatraemia among children: a randomized controlled trial

Area of Science:

• Pediatric hospital medicine
• Clinical fluid therapy
• Electrolyte balance

Background:

• Hyponatraemia, a common electrolyte disturbance in hospitalized children, can lead to significant morbidity.
• Intravenous (i.v.) fluid composition and administration rates are critical factors in preventing i.v. fluid-induced hyponatraemia.
• Understanding the optimal i.v. fluid strategy is essential for pediatric patient care.

Purpose of the Study:

• To compare the incidence of hyponatraemia in hospitalized children (3 months to 12 years) receiving three different i.v. fluid regimens.
• To determine the most effective i.v. fluid composition and rate for preventing hyponatraemia in pediatric patients.
• To inform clinical guidelines for i.v. fluid management in pediatric hospital settings.

Main Methods:

• A randomized controlled trial involving 167 hospitalized children requiring i.v. maintenance fluids for at least 24 hours.
• Patients were allocated to three groups: Group A (0.9% saline in 5% dextrose at standard rate), Group B (0.18% saline in 5% dextrose at standard rate), and Group C (0.18% saline in 5% dextrose at two-thirds standard rate).
• The primary outcome was the incidence of hyponatraemia, defined as plasma sodium < 130 mEq/L.

Main Results:

• Hyponatraemia developed in 14.3% of children in Group B, compared to 1.72% in Group A and 3.8% in Group C.
• The incidence of hyponatraemia was significantly lower in children receiving 0.9% saline in 5% dextrose (Group A) compared to 0.18% saline in 5% dextrose (Group B).
• Reducing the fluid rate to two-thirds of the standard maintenance rate (Group C) also appeared to reduce hyponatraemia incidence compared to the standard rate with hypotonic fluids (Group B).

Conclusions:

• Administration of 0.9% saline in 5% dextrose as i.v. maintenance fluid is effective in reducing the incidence of hospital-acquired hyponatraemia in children.
• Hypotonic i.v. fluids (0.18% saline in 5% dextrose) at standard maintenance rates are associated with a higher risk of hyponatraemia in pediatric patients.
• These findings support the use of isotonic saline-based i.v. fluids for maintenance therapy in hospitalized children to prevent hyponatraemia.