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What routine intravenous maintenance fluids should be used?
  1. N P Mann
  1. Correspondence to:
    Dr N P Mann
    Npmann2aol.com

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An introduction to the debate

Intravenous maintenance fluid is widely used in general paediatric practice and more children who come into hospital receive intravenous fluid than in the past. The intravenous route is frequently used because enteral maintenance or rehydration treatment is more labour intensive and uses valuable staff time; furthermore modern pumps for delivery of fluids are safe. Nevertheless in developing countries the enteral route is still more widely used even for sick dehydrated children.

Are there are any dangers of intravenous fluids? Clearly there is a possibility of miscalculation of infusion rates and also the potential for mistakes in terms of dosing errors with additives. It has been widely recognised in recent years that there is a high incidence of hyponatraemia in children treated with intravenous maintenance fluids. Is this because of excessive water or too little salt?

Moritz and Ayus discussed the high frequency of hyponatraemia in these children in their paper in Pediatrics in February 2003.1 They suggested the use of isotonic saline rather than use of hypotonic fluids for maintenance therapy. More than 20 years ago there were concerns about profound neonatal hyponatraemia causing neurological problems in infants as the result of either excessive or the wrong kind of fluid given to mothers during labour.2

It is therefore timely to revisit this problem. Two experts have been asked to give their views to encourage further debate (see accompanying articles3,4). Do write to ADC with your comments about how paediatric practice in this area can be improved.

An introduction to the debate

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