Hypotonic versus isotonic saline in hospitalised children:A systematic review

Karen Choong ^1*, Michelle Kho ², Kusum Menon ³ and Desmond Bohn ⁴

¹ McMaster Children's Hospital, McMaster University, Canada
² McMaster University, Canada
³ Children's Hospital of Eastern Ontario, University of Ottawa., Canada
⁴ Hospital for Sick Children, University of Toronto, Canada

^* To whom correspondence should be addressed. E-mail: choongk{at}mcmaster.ca.

Accepted 24 May 2006

Abstract

Background: The traditional recommendations which suggest that hypotonic intravenous (IV) maintenance fluids are the solutions of choice in pediatric patients have not been rigorously tested in clinical trials, and may not be appropriate for all children.

Objectives: To systematically review the evidence from studies evaluating the safety of administering hypotonic versus isotonic iv maintenance fluids in hospitalized children.

Data Sources: MEDLINE (1966 - 2006), EMBASE (1980- 2006), the Cochrane Library, abstract proceedings, personal files and reference lists.

Study Selection: Studies that compared hypotonic to isotonic maintenance solutions in children. We excluded case reports and studies in neonates or patients with a pre-existing history of hyponatremia.

Data collection and analysis: In duplicate and independently, we performed data abstraction and quality assessment. Data Synthesis: Six studies met our selection criteria. A meta-analysis combining these studies showed that hypotonic solutions significantly increased the risk of developing acute hyponatremia (OR 17.22; 95% CI 8.67, 34.2, and resulted in greater patient morbidity.

Conclusions: The current practice of prescribing iv maintenance fluids in children is based on limited clinical experimental evidence from poorly and differently designed studies, where bias could possibly raise doubt about the results. They do not provide evidence for optimal fluid and electrolyte homeostasis in hospitalized children. This systematic review indicates potential harm with hypotonic solutions in children, which can be anticipated and avoided with isotonic solutions. No single fluid rate or composition is ideal for all children. However isotonic or near- isotonic solutions may be more physiologic, and therefore a safer choice in the acute phase of illness and peri-operative period.

Keywords: hyponatremia, hypotonic Saline, isotonic Saline, systematic review

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