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Are we giving too much IV fluid?

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The importance of prompt resuscitation with intravenous (IV) fluids in children with presumed sepsis or severe dehydration is well-known, and is emphasised in all resuscitation guidelines. But have we gone too far? The FEAST trial published in 2011 set alarm bells ringing (doi: 10.1056/NEJMoa1101549). In a sub-Saharan Africa setting, it showed that very ill, febrile children randomised to fluid boluses of either saline or albumin had a 3.3% higher mortality than those receiving only maintenance fluids. Those with gastro-enteritis were excluded. Since then questions have been asked about whether we might also be doing harm to less ill children in Western settings by overuse of fluids. …

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