Intravenous maintenance fluids revisited

Area of Science:

• Pediatric Medicine
• Nephrology
• Critical Care

Background:

• Intravenous (IV) maintenance fluid therapy replaces fluid and electrolyte losses in children unable to take fluids orally.
• Traditional fluid therapy, based on Holliday and Segar (1957), often uses hypotonic fluids.
• Hypotonic fluids may be suboptimal in ill children with altered physiology, potentially increasing hyponatremia risk.

Purpose of the Study:

• To review the evidence supporting the use of isotonic versus hypotonic IV maintenance fluids in pediatric patients.
• To highlight the risks associated with traditional hypotonic fluid therapy in hospitalized children.

Main Methods:

• Literature review of studies published over the last two decades.
• Analysis of evidence regarding fluid composition and its impact on electrolyte balance in pediatric patients.
• Examination of physiological factors influencing fluid and electrolyte requirements in hospitalized children.

Main Results:

• Evidence suggests that hypotonic IV fluids are associated with an increased incidence of hyponatremia in hospitalized children.
• Contemporary pediatric patients often have physiological derangements that make hypotonic fluids less suitable.
• Isotonic fluids are increasingly recognized as a safer alternative for IV maintenance therapy.

Conclusions:

• A shift from hypotonic to isotonic intravenous maintenance fluids is recommended for pediatric patients.
• This change in fluid management may reduce the incidence of iatrogenic hyponatremia.
• Updated fluid therapy guidelines are needed to reflect current evidence and improve patient safety.