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A balancing act: drifting away from the reflexive use of "ab"normal saline

Linda Wang1, Celeste Dixon2, Jennifer Nhan3

  • 1Department of Pediatrics, Division of Nephrology, Children's National Hospital, Washington, DC, USA. lwang4@childrensnational.org.

Pediatric Nephrology (Berlin, Germany)
|January 17, 2024
PubMed

Insights

Pediatric patients receiving 0.9% saline for maintenance intravenous fluids may experience adverse effects like metabolic acidosis. Balanced solutions are recommended for safer fluid therapy in children.

Area of Science:

  • Pediatric Medicine
  • Clinical Pharmacology
  • Nephrology

Background:

  • Maintenance intravenous fluids are common in hospitalized children.
  • National guidelines led to increased use of isotonic solutions, particularly 0.9% saline, to prevent hyponatremia.
  • The use of 0.9% saline may have unintended consequences.

Purpose of the Study:

  • To review the potential adverse effects of 0.9% saline in pediatric patients.
  • To compare the safety and efficacy of balanced solutions versus 0.9% saline.
  • To emphasize individualized fluid therapy in children.

Main Methods:

  • Educational review of existing literature.
  • Analysis of studies comparing saline and balanced solutions.
  • Discussion of physiological effects of different intravenous fluids.

Main Results:

  • 0.9% saline can lead to hyperchloremia, metabolic acidosis, acute kidney injury, and hyperkalemia.
  • Balanced solutions with anion buffers generally cause less harm in pediatric patients.
  • Evidence comparing fluid choices is variable, but benefits of balanced solutions are highlighted.

Conclusions:

  • Balanced solutions may be preferable to 0.9% saline for maintenance intravenous fluids in children.
  • Individualized patient assessment is crucial for optimal fluid therapy.
  • Avoiding potential harms associated with 0.9% saline is important in pediatric care.

Keywords:
0.9% salineBalanced solutionsHyperchloremiaIntravenous fluids

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