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Isotonic versus Hypotonic Parenteral Maintenance Fluids in Very Severe Pneumonia

Subramaniam Ramanathan1, Praveen Kumar1, Kirtisudha Mishra2

  • 1Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, 110001, India.

Indian Journal of Pediatrics
|June 2, 2015
PubMed

Insights

Isotonic parenteral maintenance solutions (PMS) are safer than hypotonic PMS for children with very severe pneumonia, significantly reducing the risk of hyponatremia.

Area of Science:

  • Pediatrics
  • Clinical Medicine
  • Medical Research

Background:

  • Very severe pneumonia is a common pediatric illness requiring intravenous fluid therapy.
  • Hyponatremia is a potential complication of fluid management in children with pneumonia.
  • Parenteral maintenance solutions (PMS) are crucial for maintaining fluid and electrolyte balance.

Purpose of the Study:

  • To compare the incidence of hyponatremia in children with very severe pneumonia receiving either hypotonic or isotonic parenteral maintenance solutions (PMS).

Main Methods:

  • A randomized controlled open-label trial involved 119 euvolemic children aged 2 months to 5 years with very severe pneumonia.
  • Participants received either isotonic (0.9% saline) or hypotonic (0.18% saline) PMS for 24 hours.
  • Serum sodium levels were monitored at 6, 12, and 24 hours.

Main Results:

  • The hypotonic PMS group had a significantly higher incidence of hyponatremia (48%) compared to the isotonic PMS group (15%).
  • The relative risk of developing hyponatremia was 3.16 times higher in the hypotonic group.
  • Mean serum sodium levels were significantly lower in children receiving hypotonic PMS at all measured time points.

Conclusions:

  • Isotonic PMS is recommended for children with respiratory infections like very severe pneumonia to prevent hyponatremia.
  • This finding supports the rational use of isotonic fluids in managing pediatric respiratory illnesses.
  • The study highlights the importance of fluid composition in preventing electrolyte disturbances in hospitalized children.
Abstract

Keywords:
HyponatremiaMaintenance fluidPediatricsPneumonia

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