[Perioperative fluid management in infants and toddlers]

The more than 50 years ago of Holiday and Segar created fundamentals of fluid therapy with sodium hypotonic solutions require revision. Hypotonic electrolyte solutions should not be longer used perioperatively. To maintain the water balance in the perioperative phase stable, children need balanced electrolyte solutions, corresponding to the composition of the extracellular space. Routine glucose supply is not required, only children with an increased risk of hypoglycemia, such as newborns, need a supply of glucose as well as a monitoring of serum glucose. The historic 4-2-1-rule should be replaced by a simpler approach. Fasting deficit and intraoperative maintenance requirement will be covered by an increased rate of infusion of a balanced electrolyte solution. Intraoperative losses and correction needs to be replaced according to clinical criteria. Balanced electrolyte solution with and without 1% glucose are very safe with respect to hyponatremia, hypo-and hyperglycemia, and accidental overinfusion.