[Which maintenance intravenous fluid in paediatrics in 2015?]

Area of Science:

• Pediatric Medicine
• Intravenous Fluid Therapy
• Electrolyte Balance

Context:

• For five decades, hypotonic solutions have been the standard for pediatric maintenance fluid therapy, based on Holliday and Segar's work.
• Over the past twenty years, accumulating evidence has indicated a significant association between hypotonic fluid administration and the development of hyponatremia in children.
• Recent high-quality research, including meta-analyses and randomized controlled trials, challenges the long-standing use of hypotonic fluids.

Purpose:

• To review the current evidence regarding the safety and efficacy of hypotonic maintenance intravenous fluids in pediatric patients.
• To evaluate the risk of hyponatremia associated with hypotonic fluid therapy in hospitalized children.
• To provide updated recommendations for optimal intravenous fluid management in pediatric care.

Summary:

• Hypotonic solutions, historically recommended for pediatric maintenance fluid therapy, are increasingly recognized as a risk factor for iatrogenic hyponatremia.
• Robust scientific literature, including recent meta-analyses and randomized studies, demonstrates that hypotonic fluids are inappropriate for hospitalized pediatric patients, whether medically or surgically ill.
• The findings strongly support a paradigm shift away from hypotonic fluids towards isotonic saline solutions for maintenance intravenous fluid therapy in children.

Impact:

• This evidence necessitates a revision of current pediatric intravenous fluid therapy guidelines.
• Adoption of isotonic saline solutions is recommended to mitigate the risk of hyponatremia and improve patient outcomes.
• This shift in practice aims to enhance the safety of fluid management in hospitalized pediatric populations.