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From hypotonic maintenance fluid to severe hyponatremia: a case report
M Denis1,2,3,4, A Di Giacomo5, E Lacotte5,6,7
1Pediatric Intensive Care Unit, CHU de Caen, 14000, Caen, France. manon.denis@chu-nantes.fr.
Journal of Medical Case Reports
|June 8, 2021
Summary
Hypotonic maintenance fluids in children risk severe hyponatremia. The American Academy of Pediatrics now recommends isotonic fluids for pediatric intravenous therapy to prevent these complications.
Area of Science:
- Pediatric Medicine
- Clinical Case Study
- Intravenous Fluid Therapy
Background:
- Traditional pediatric maintenance intravenous fluid guidelines, established in the 1950s, primarily utilized hypotonic solutions.
- Concerns have been raised regarding these older guidelines due to their association with an increased incidence of hospital-acquired hyponatremia in children.
Observation:
- A case report details a 4-week-old infant admitted with acute bronchiolitis.
- The infant was administered hypotonic maintenance fluids during their hospital stay.
Findings:
- The patient developed severe hyponatremia, with serum sodium levels dropping to 94 mmol/L.
- This severe electrolyte imbalance led to the development of hyponatremic encephalopathy.
Implications:
- This case underscores the potential dangers of using hypotonic fluids in pediatric care.
- It highlights the importance of adhering to current recommendations, such as those from the American Academy of Pediatrics, favoring isotonic fluids for pediatric intravenous fluid management.
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