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Owing to incorrect authorship listed in the online March issue the following letters are republished here.
Even though we believe these papers have been well designed and developed, we cannot agree with their results for we are carrying out a similar study in our centre (81 cases up to now) that is leading to the opposite conclusion: our children with gastroenteritis did not develop hyponatraemia even though they were all treated with hypotonic intravenous solutions (0.3% saline with 5% glucose), while isotonic fluids were only used in “preshock” situations.
The incidence of hyponatraemia at the time of diagnosis is lower in our study (9%) than in those published previously (range 30–50%); this could be due to differences in climate or diet.
In the analysis, we separated children according to whether they were hyponatraemic, normonatraemic, or hypernatraemic at presentation. In the first group, hypotonic intravenous saline increased mean plasma sodium (from 132.4 (SD 2.07) to 135.3 (SD 2.21) mEq/l); it was decreased slightly in the second group, without leading to hyponatraemia (139.2 (SD 2.9) to 137.3 (SD 2.9) mEq/l), and also in the third group (150.4 (SD 4.12) to 140.6 (SD 3.6) mEq/l). No cases of hyponatraemia post-infusion were seen. Hoorn and colleagues,4 in a sample of 1586 children, showed that the cases of hyponatraemia in their study were due to incorrect treatment, with higher volumes of fluid than needed.
In our study, 10 children (16.3%) presented with glucose levels lower than 70 mg/dl (40 mg/dl in one case). If these children were treated with isotonic fluids without adequate glucose, levels would never increase, with serious consequences.
These data are not definitive, but should be taken into consideration before selecting an appropriate solution in these patients. Further studies with different designs are required.