Fluids in shock

An article recently published in the NEJM by Maitland et al caused a stir, both among paediatricians and in the press: they claimed that, at least in the context of their trial with African children, giving intravenous bolus resuscitation fluids to critically ill children actually increased mortality.1 This clearly flies in the face of standard teaching. Southall and Samuels present a critique of that study, arguing that many of their subjects were not in hypovolaemic shock at all, but just very ill with febrile illnesses such as pneumonia and malaria.

Although Maitland claims that these findings are applicable in Western healthcare settings, Southall urges caution in making this extrapolation. This debate will go on, but it should certainly make us think carefully before automatically giving sick children large boluses, as seems to be increasingly popular. Other acute febrile illnesses can mimic the signs of shock, and too much fluid can indeed be harmful if the diagnosis is wrong. See page 905

Sex chromosomes and autism

Many of us will remember …