ORIGINAL ARTICLE

Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study

K A Neville¹, C F Verge¹, A R Rosenberg², M W O’Meara³, J L Walker¹

¹ Department of Endocrinology, Sydney Children’s Hospital, Sydney, Australia
² Department of Nephrology, Sydney Children’s Hospital, Sydney, Australia
³ Emergency Department, Sydney Children’s Hospital, Sydney Australia

Correspondence to:
Dr K Neville
Department of Endocrinology, Sydney Children’s Hospital, High St Randwick, NSW 2031, Australia; kristen.neville{at}sesiahs.health.nsw.gov.au

Aims: To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous (IV) fluids is decreased by the use of 0.9% saline.

Methods: A prospective randomised study was carried out in a tertiary paediatric hospital. A total of 102 children with gastroenteritis were randomised to receive either 0.9% saline + 2.5% dextrose (NS) or 0.45% saline + 2.5% dextrose (N/2) at a rate determined by their treating physician according to hospital guidelines and clinical judgement. Plasma electrolytes, osmolality, and plasma glucose were measured before (T₀) and 4 hours after (T₄) starting IV fluids, and subsequently if clinically indicated. Electrolytes and osmolality were measured in urine samples. Results were analysed according to whether children were hyponatraemic (plasma sodium <135 mmol/l) or normonatraemic at T₀.

Results: At T₀, mean (SD) plasma sodium was 135 (3.3) mmol/l (range 124–142), with 37/102 (36%) hyponatraemic. At T₄, mean plasma sodium in children receiving N/2 remained unchanged in those initially hyponatraemic (n = 16), but fell 2.3 (2.2) mmol/l in the normonatraemic group. In contrast, among children receiving NS, mean plasma sodium was 2.4 (2.0) mmol/l higher in those hyponatraemic at baseline (n = 21) and unchanged in the initially normonatraemic children. In 16 children who were still receiving IV fluids at 24 hours, 3/8 receiving N/2 were hyponatraemic compared with 0/8 receiving NS. No child became hypernatraemic.

Conclusions: In gastroenteritis treated with intravenous fluids, normal saline is preferable to hypotonic saline because it protects against hyponatraemia without causing hypernatraemia.

Abbreviations: ADH, antidiuretic hormone; IV, intravenous; RRP, rapid replacement protocol; SRP, slow replacement protocol

Keywords: sodium; gastroenteritis; fluid therapy; infusions intravenous; dehydration

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