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0.45% Versus 0.9% Saline in 5% Dextrose as Maintenance Fluids in Children Admitted With Acute Illness: A Randomized
Kumar Ratnjeet1, Pallavi Pallavi, Urmila Jhamb
1From the Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
Insights
Isotonic intravenous (IV) fluids are safer for children than hypotonic fluids. This study found a higher risk of hyponatremia with hypotonic IV fluids in hospitalized children.
Area of Science:
- Pediatric Medicine
- Clinical Research
- Fluid and Electrolyte Balance
Background:
- Concerns exist regarding the safety of traditional hypotonic intravenous (IV) maintenance fluids, particularly the risk of iatrogenic hyponatremia in children.
- Current practices for IV fluid selection in pediatric patients vary globally.
- This study addresses the need for evidence-based guidelines on IV fluid composition for hospitalized children.
Purpose of the Study:
- To compare the effects of 0.45% saline (hypotonic) versus 0.9% saline (isotonic) in 5% dextrose on serum sodium levels in children.
- To assess the incidence of hyponatremia and hypernatremia in pediatric patients receiving different IV fluid formulations.
- To evaluate serum sodium changes at 24, 48, and 72 hours post-initiation of IV fluid therapy.
Main Methods:
- An open-label, randomized controlled trial involving 200 children aged 3 months to 12 years.
- Participants were randomized to receive either 0.45% saline in 5% dextrose or 0.9% normal saline in 5% dextrose.
- Serum sodium levels were monitored at baseline, 12, 24, and potentially 48/72 hours.
Main Results:
- A statistically significant fall in serum sodium from baseline was observed in the 0.45% saline group compared to the 0.9% saline group at 24 hours (P < 0.001).
- The incidence of mild and moderate hyponatremia was significantly higher in the hypotonic (0.45% saline) group at 12 and 24 hours (P < 0.001).
- No significant difference in serum sodium levels or hyponatremia incidence was noted between groups at 48 hours.
Conclusions:
- Hypotonic IV fluids (0.45% saline in 5% dextrose) are associated with a significant risk of hyponatremia in hospitalized children at 12 and 24 hours.
- Isotonic IV fluids (0.9% normal saline in 5% dextrose) appear to be a safer choice for maintenance fluid therapy in this population.
- These findings suggest a need to reconsider traditional IV fluid recommendations and favor isotonic solutions for pediatric patients.
Background:
The safety of giving intravenous (IV) maintenance fluids according to Holliday and Segar's recommendations of 1957 has recently been questioned after reports of complications caused by iatrogenic hyponatremia in children receiving hypotonic fluids. However, the current practice of choice of maintenance IV fluids for hospitalized children varies worldwide. This study was planned to compare 0.45% and 0.9% saline in 5% dextrose at standard maintenance rates in hospitalized children aged 3 months to 12 years.
Objective:
Primary objective was to study change in serum sodium level at 24 hours in children receiving total IV fluid maintenance therapy as 0.45% or 0.9% normal saline in 5% dextrose. Secondary objectives of this study were to estimate change in serum sodium levels from the baseline to 48 or 72 hours, if IV fluids were continued, and to find incidence of hyponatremia and hypernatremia after administering these 2 types of maintenance fluids.
Methods:
This study was an open-label, randomized control trial conducted at the Department of Pediatrics of a tertiary care hospital from July 22, 2019, to October 28, 2019. Two hundred children aged 3 months to 12 years admitted in pediatric emergency and requiring IV maintenance fluid were randomized into 2 groups (group A received 0.45% saline in 5% dextrose, group B received 0.9% normal saline in 5% dextrose) with 100 in each group.
Results:
Both groups were comparable for baseline characteristics. Fall in mean serum sodium from baseline was more with increasing duration of IV fluids until 24 hours in 0.45% saline group as compared with 0.9% saline group, which was statistically significant (P < 0.001). The incidence of mild and moderate hyponatremia was significantly more in hypotonic group at 12 hours (P < 0.001) and 24 hours (P < 0.001). However, there was no significant difference at 48 hours.
Conclusions:
The fall in serum sodium values was significant, and there was significant risk of hyponatremia with the use of hypotonic fluids at 12 and 24 hours. Hence, the use of isotonic fluids seems to be more appropriate among the hospitalized children.Trial Registration: CTRI/2019/10/021791.
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